Provider Demographics
NPI:1780385450
Name:MEDINA-RODRIGUEZ, MANUEL ANDRES (DC)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANDRES
Last Name:MEDINA-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 1:1353 AVE. LUIS VIGOREAUX
Mailing Address - Street 2:PMB 803
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:939-642-6959
Mailing Address - Fax:
Practice Address - Street 1:AVE. CASA LINDA #1 SUITE 101
Practice Address - Street 2:CARR 177 LOS FILTROS KM 2.0
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor