Provider Demographics
NPI:1992043251
Name:IMANA, RODRIGO ADRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:ADRIAN
Last Name:IMANA
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 1:315 W 57TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3148
Mailing Address - Country:US
Mailing Address - Phone:212-390-8169
Mailing Address - Fax:
Practice Address - Street 1:315 W 57TH ST STE 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3148
Practice Address - Country:US
Practice Address - Phone:212-390-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX12239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor