MEDICARE: DR. JULIA MARIE RIVERS DO

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	2301008165	MI

General Provider Information

NPI Number	:	1083711550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA MARIE RIVERS DO

Provider Business Mailing Address
First Line	:	51547 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4447
Country	:	US
Telephone Number	:	586-739-8824
Fax Number	:	586-739-8825

Provider Business Practice Location Address
First Line	:	51547 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4447
Country	:	US
Telephone Number	:	586-739-8824
Fax Number	:	586-739-8825

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

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	07/08/2007

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