Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR010446 | GA |
Y | 111NP0017X | Pediatric Chiropractor | CHIR010446 | GA |
NPI | 1235712514 |
---|---|
Provider Name | Dr. Kimberly Rodriguez |
First Address | Smyrna, GA 30080-8806 |
Second Address | Marietta, GA 30064-3560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2021 |
Last Update Date | 04/05/2021 |