Healthcare Provider Details

I. General information

NPI: 1104397801
Provider Name (Legal Business Name): JOSE M MARTINEZ RIVERA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHURCH ST STE 108
KISSIMMEE FL
34741-4442
US

IV. Provider business mailing address

400 CHURCH ST STE 108
KISSIMMEE FL
34741-4442
US

V. Phone/Fax

Practice location:
  • Phone: 407-710-1510
  • Fax: 407-775-3138
Mailing address:
  • Phone: 407-710-1510
  • Fax: 407-775-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: