Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 7427 | AZ |
NPI | 1063436962 |
---|---|
Provider Name | Dr. Jose Antonio Rodriguez |
First Address | Mesa, AZ 85206-3741 |
Second Address | Mesa, AZ 85209-6695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99367 | (02) |