Healthcare Provider Details

I. General information

NPI: 1013530583
Provider Name (Legal Business Name): REINALDO LUIS RODRIGUEZ GONZALEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MOCKINGBIRD LN STE 1000
DALLAS TX
75247-5010
US

IV. Provider business mailing address

1560 E DEBBIE LN STE 104
MANSFIELD TX
76063-8575
US

V. Phone/Fax

Practice location:
  • Phone: 214-920-9111
  • Fax:
Mailing address:
  • Phone: 817-453-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: