Provider Demographics
NPI:1750304499
Name:RODRIQUEZ, MARCOS S (DC)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:S
Last Name:RODRIQUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6506
Mailing Address - Country:US
Mailing Address - Phone:972-984-1404
Mailing Address - Fax:888-509-1466
Practice Address - Street 1:2529 FOREST LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6506
Practice Address - Country:US
Practice Address - Phone:972-984-1404
Practice Address - Fax:888-509-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8W7900OtherBCBS OF TX