Provider Demographics
NPI:1720009350
Name:RODRIGUEZ, CORI (DC)
Entity Type:Individual
Prefix:DR
First Name:CORI
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:543 N WYMORE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4270
Mailing Address - Country:US
Mailing Address - Phone:407-628-1207
Mailing Address - Fax:407-628-9029
Practice Address - Street 1:543 N WYMORE RD STE 103
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4270
Practice Address - Country:US
Practice Address - Phone:407-628-1207
Practice Address - Fax:407-628-9029
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70285AMedicare ID - Type Unspecified