MEDICARE: JEFFREY J 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	5590	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8U4790	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1497768493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY J RODRIGUEZ D.C.

Provider Business Mailing Address
First Line	:	PO BOX 781667
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75378-1667
Country	:	US
Telephone Number	:	214-352-3000
Fax Number	:	214-358-2418

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY
Second Line	:	STE 3100
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-352-3000
Fax Number	:	214-358-2418

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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