Provider Demographics
NPI:1760792295
Name:RODRIGUEZ, ANTONIO DOMINIC (DC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:DOMINIC
Last Name:RODRIGUEZ
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 1:2545 ARMSTRONG PLACE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5511
Mailing Address - Country:US
Mailing Address - Phone:858-442-5519
Mailing Address - Fax:
Practice Address - Street 1:2545 ARMSTRONG PLACE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5511
Practice Address - Country:US
Practice Address - Phone:858-442-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor