MEDICARE: RIVERA CHIROPRACTIC CORPORATION

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

General Provider Information

NPI Number	:	1396688560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERA CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	1850 S WATERMAN AVE STE C
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 S WATERMAN AVE STE C
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-712-5676
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	JUAN PABLO RIVERA RODRIGUEZ
Credential	:	DC
Telephone Number	:	909-712-5676

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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