Provider Demographics
NPI:1124340419
Name:RODRIGUEZ, ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
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 1:1060 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3103
Mailing Address - Country:US
Mailing Address - Phone:360-423-2037
Mailing Address - Fax:
Practice Address - Street 1:1518 BISHOP RD SW # 11
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7354
Practice Address - Country:US
Practice Address - Phone:360-923-5588
Practice Address - Fax:360-915-9815
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60136257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor