Healthcare Provider Details

I. General information

NPI: 1124965314
Provider Name (Legal Business Name): ROBERTO RIVERA CHIROPRACTIC P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 TERMINAL WAY
COSTA MESA CA
92627-3616
US

IV. Provider business mailing address

640 TERMINAL WAY
COSTA MESA CA
92627-3616
US

V. Phone/Fax

Practice location:
  • Phone: 718-702-9450
  • Fax:
Mailing address:
  • Phone: 718-702-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO RIVERA JR.
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 718-702-9450