Healthcare Provider Details

I. General information

NPI: 1558277608
Provider Name (Legal Business Name): ANYA ELIZONDO RODRIGUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W MONTGOMERY ST
WILLIS TX
77378-8830
US

IV. Provider business mailing address

1805 TAVISH LN
CONROE TX
77301-4157
US

V. Phone/Fax

Practice location:
  • Phone: 936-890-2273
  • Fax:
Mailing address:
  • Phone: 936-697-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17006
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: