Provider Demographics
NPI:1205951423
Name:RODRIGUEZ, ANIELLO (DC)
Entity type:Individual
Prefix:DR
First Name:ANIELLO
Middle Name:
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 1:1000 PEACHTREE INDUSTRIAL BLVD # 6-306
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6737
Mailing Address - Country:US
Mailing Address - Phone:678-205-8808
Mailing Address - Fax:678-205-8818
Practice Address - Street 1:860 DULUTH HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5326
Practice Address - Country:US
Practice Address - Phone:678-205-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO006997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA201464935OtherTAX ID#
GA201464935OtherTAX ID#