Individual
ELIS X RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2615 HARRISON ST, BELLWOOD, IL 60104-2450
(847) 801-5170
Mailing address
6615 W BELMONT AVE APT 3, CHICAGO, IL 60634-4283
(773) 216-2438
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003734
IL
Other
Enumeration date
03/13/2014
Last updated
03/13/2014
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