=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295754976
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSVALDO ANGEL RODRIGUEZ D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 W BROAD ST
-----------------------------------------------------
City | QUAKERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18951-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-536-4002
-----------------------------------------------------
Fax | 215-536-4002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 W BROAD ST
-----------------------------------------------------
City | QUAKERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18951-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-536-4002
-----------------------------------------------------
Fax | 215-536-4002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | DC007387L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 38MC00589200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------