Provider Demographics
NPI:1821768144
Name:RODRIGUEZ, MICHAEL I (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
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 1:1308 CALLE LUCHETTI CONDOMINIO EL TAINO
Mailing Address - Street 2:APARTMENTO #503
Mailing Address - City:SANJUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1000
Mailing Address - Country:US
Mailing Address - Phone:787-513-5325
Mailing Address - Fax:
Practice Address - Street 1:D14 CALLE BUEN SAMARITANO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2025
Practice Address - Country:US
Practice Address - Phone:787-792-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty