MEDICARE: LEE & RODRIGUEZ CHIRO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	25613	CA

General Provider Information

NPI Number	:	1144673245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE & RODRIGUEZ CHIRO INC

Provider Business Mailing Address
First Line	:	569 S AZUSA WAY
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5113
Country	:	US
Telephone Number	:	626-854-1144
Fax Number	:	626-854-1804

Provider Business Practice Location Address
First Line	:	569 S AZUSA WAY
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5113
Country	:	US
Telephone Number	:	626-854-1144
Fax Number	:	626-854-1804

Authorized Official
Title or Position	:	CEO
Name	:	DR. OSCAR RODRIGUEZ
Credential	:	DC
Telephone Number	:	626-854-1144

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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