Healthcare Provider Details

I. General information

NPI: 1003727793
Provider Name (Legal Business Name): JACOB RIVARD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W PLATT ST STE 2
TAMPA FL
33606-4112
US

IV. Provider business mailing address

6757 16TH TER N APT 385
SAINT PETERSBURG FL
33710-5450
US

V. Phone/Fax

Practice location:
  • Phone: 813-515-5007
  • Fax: 813-515-5079
Mailing address:
  • Phone: 906-792-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: