Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 38MC00589200 | NJ |
Y | 111NS0005X | Chiropractic Sports Physician | DC007387L | PA |
NPI | 1295754976 |
---|---|
Provider Name | Dr. Osvaldo Angel Rodriguez |
First Address | Quakertown, PA 18951-1107 |
Second Address | Quakertown, PA 18951-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039213 | BLUE SHIELD (01) | PA |
U73213 | (02) | PA |