Provider Demographics
NPI:1780274761
Name:RODRIGUES, BENJAMIN AUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:AUSTIN
Last Name:RODRIGUES
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:W225N3799 LONG VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4184
Mailing Address - Country:US
Mailing Address - Phone:414-429-9707
Mailing Address - Fax:
Practice Address - Street 1:1177 QUAIL CT STE 103
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3768
Practice Address - Country:US
Practice Address - Phone:414-429-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5611-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor