MEDICARE: DR. ANIELLO RODRIGUEZ DC

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	CHIRO006997	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201464935	OTHER	GA	TAX ID#

General Provider Information

NPI Number	:	1205951423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANIELLO RODRIGUEZ DC

Provider Business Mailing Address
First Line	:	1000 PEACHTREE INDUSTRIAL BLVD # 6-306
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6737
Country	:	US
Telephone Number	:	678-205-8808
Fax Number	:	678-205-8818

Provider Business Practice Location Address
First Line	:	860 DULUTH HWY
Second Line	:	SUITE 100
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5326
Country	:	US
Telephone Number	:	678-205-8808
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/09/2011

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