=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407039944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J & J FOOT CLINICS, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 12/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 TIGER CT
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60490-2052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-364-1917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 TIGER CT
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60490-2052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-364-1917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES RONALD RODRIGUEZ
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 630-364-1917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------