Healthcare Provider Details

I. General information

NPI: 1487474656
Provider Name (Legal Business Name): JEFFREY RODRIGUEZ PRUNET D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4744 WALDEN CIR APT 931
ORLANDO FL
32811-7160
US

IV. Provider business mailing address

4744 WALDEN CIR APT 931
ORLANDO FL
32811-7160
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-4025
  • Fax:
Mailing address:
  • Phone: 787-590-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: