Provider Demographics
NPI:1063436962
Name:RODRIGUEZ, JOSE ANTONIO (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:RODRIGUEZ
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 1:1234 S POWER RD STE 151
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3741
Mailing Address - Country:US
Mailing Address - Phone:480-985-7070
Mailing Address - Fax:480-641-7408
Practice Address - Street 1:2509 S POWER RD
Practice Address - Street 2:#115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6695
Practice Address - Country:US
Practice Address - Phone:480-985-7070
Practice Address - Fax:480-641-7408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7427111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
99367Medicare UPIN