Provider Demographics
NPI:1487928115
Name:ROBERT J. RODRIGUEZ, D.C.,P.A.
Entity type:Organization
Organization Name:ROBERT J. RODRIGUEZ, D.C.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-887-5560
Mailing Address - Street 1:4407 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5203
Mailing Address - Country:US
Mailing Address - Phone:813-887-5560
Mailing Address - Fax:813-885-7123
Practice Address - Street 1:4407 KELLY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5203
Practice Address - Country:US
Practice Address - Phone:813-887-5560
Practice Address - Fax:813-885-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381261800Medicaid