Provider Demographics
NPI:1548252075
Name:RODRIGUEZ, MICHAEL J (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
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 1:90 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5637
Mailing Address - Country:US
Mailing Address - Phone:386-672-6243
Mailing Address - Fax:386-677-7463
Practice Address - Street 1:545 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5103
Practice Address - Country:US
Practice Address - Phone:386-672-6243
Practice Address - Fax:386-677-7463
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88284Medicare ID - Type Unspecified
FLT85836Medicare UPIN
FL050047000Medicare ID - Type Unspecified