MEDICARE: GLENDA RODRIGUEZ

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	111NR0400X	Rehabilitation Chiropractor	6893	TX

General Provider Information

NPI Number	:	1356729305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA RODRIGUEZ

Provider Business Mailing Address
First Line	:	12000 WILCREST DR STE 203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1924
Country	:	US
Telephone Number	:	832-633-6175
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 WILCREST DR STE 203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1924
Country	:	US
Telephone Number	:	832-633-6175
Fax Number	:

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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Directions to “ GLENDA RODRIGUEZ ” Practice Location

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