Healthcare Provider Details

I. General information

NPI: 1285543918
Provider Name (Legal Business Name): EDGARD A RODRIGUEZ DC,BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SE 17TH ST STE 103
FORT LAUDERDALE FL
33316-1735
US

IV. Provider business mailing address

1650 SE 17TH ST STE 103
FORT LAUDERDALE FL
33316-1735
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-5483
  • Fax:
Mailing address:
  • Phone: 954-368-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH16093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: