MEDICARE: DR. JESUS EMMANUEL ANDINO RODRIGUEZ DC

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	CIR011229	GA

General Provider Information

NPI Number	:	1548086135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS EMMANUEL ANDINO RODRIGUEZ DC

Provider Business Mailing Address
First Line	:	5010 PACES STATION DR UNIT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4055
Country	:	US
Telephone Number	:	787-215-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 PACES STATION DR UNIT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4055
Country	:	US
Telephone Number	:	787-215-6009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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