MEDICARE: ROBERTO RIVERA CHIROPRACTIC P.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	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1124965314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO RIVERA CHIROPRACTIC P.C

Provider Business Mailing Address
First Line	:	640 TERMINAL WAY
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3616
Country	:	US
Telephone Number	:	718-702-9450
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 TERMINAL WAY
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3616
Country	:	US
Telephone Number	:	718-702-9450
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROBERTO RIVERA JR.
Credential	:	DC
Telephone Number	:	718-702-9450

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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