Provider Demographics
NPI:1770790305
Name:RODRIGUEZ, JAIRO (DC DACBN CCN)
Entity type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC DACBN CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CENTRAL PARK WEST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-489-7494
Mailing Address - Fax:212-489-7692
Practice Address - Street 1:25 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-489-7494
Practice Address - Fax:212-489-7692
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2331111N00000X
NY003798133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist