Healthcare Provider Details

I. General information

NPI: 1104834803
Provider Name (Legal Business Name): GREGORY L LARIVEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-6847
US

IV. Provider business mailing address

920 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-6847
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-7707
  • Fax: 561-748-5502
Mailing address:
  • Phone: 561-747-7707
  • Fax: 561-748-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 8805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: