MEDICARE: HUMBERTO 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	5710	FL

General Provider Information

NPI Number	:	1275649451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMBERTO RODRIGUEZ DC

Provider Business Mailing Address
First Line	:	2724 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6005
Country	:	US
Telephone Number	:	786-360-6355
Fax Number	:	786-536-4319

Provider Business Practice Location Address
First Line	:	2724 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6005
Country	:	US
Telephone Number	:	786-360-6355
Fax Number	:	786-536-4219

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/28/2012

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