Provider Demographics
NPI:1962491340
Name:RODRIGUEZ, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
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 1:4407 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5203
Mailing Address - Country:US
Mailing Address - Phone:813-887-5560
Mailing Address - Fax:813-885-7123
Practice Address - Street 1:4407 KELLY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5203
Practice Address - Country:US
Practice Address - Phone:813-887-5560
Practice Address - Fax:813-885-7123
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381261800Medicaid
FLCH0003444OtherSTATE LICENSE
FLT55879Medicare UPIN
FL88550Medicare ID - Type Unspecified