MEDICARE: DR. JOHN C RODRIGUEZ D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3616	OH
2	111N00000X	Chiropractor	26309	CA

General Provider Information

NPI Number	:	1083687495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C RODRIGUEZ D.C.

Provider Business Mailing Address
First Line	:	6378 EWE DR
Second Line	:
City	:	CLINTON
State	:	OH
Zip	:	44216-8643
Country	:	US
Telephone Number	:	330-882-5822
Fax Number	:

Provider Business Practice Location Address
First Line	:	843 W MAPLE ST
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-3177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/09/2007

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