Provider Demographics
NPI:1720433444
Name:RODRIGUEZ, NICOLAS (DC)
Entity Type:Individual
Prefix:
First Name:NICOLAS
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 1:9335 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3035
Mailing Address - Country:US
Mailing Address - Phone:913-271-4819
Mailing Address - Fax:
Practice Address - Street 1:535 W ELM ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-4074
Practice Address - Country:US
Practice Address - Phone:913-325-0720
Practice Address - Fax:913-335-0575
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05790111N00000X
KS0105790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty