MEDICARE: DR. TY 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	13900	TX
2	111N00000X	Chiropractor	CHIA-2004	ID

General Provider Information

NPI Number	:	1730663634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TY RODRIGUEZ DC

Provider Business Mailing Address
First Line	:	6300 RIDGLEA PL STE 128
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5711
Country	:	US
Telephone Number	:	817-708-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 RIDGLEA PL STE 128
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5711
Country	:	US
Telephone Number	:	817-708-2800
Fax Number	:

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

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2025

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Directions to “ DR. TY RODRIGUEZ DC” Practice Location

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