Provider Demographics
NPI:1821770850
Name:RODRIGUEZ TORRES, IVAN G (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:G
Last Name:RODRIGUEZ TORRES
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB JARDINES DEL CARIBE
Mailing Address - Street 2:OO-36 CALLE 49
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-298-4516
Mailing Address - Fax:
Practice Address - Street 1:1241 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0943
Practice Address - Country:US
Practice Address - Phone:787-298-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR918111N00000X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports Physician