Provider Demographics
NPI:1821769423
Name:RODRIGUEZ, JONATHAN RYAN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RYAN
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 1:6492 EMERALD DUNES DR APT 106
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2754
Mailing Address - Country:US
Mailing Address - Phone:786-479-3814
Mailing Address - Fax:
Practice Address - Street 1:1410 S POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4300
Practice Address - Country:US
Practice Address - Phone:954-772-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor