Healthcare Provider Details

I. General information

NPI: 1144462052
Provider Name (Legal Business Name): TONI LUISA RIVERA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONI L RIVERA D.C.

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7313 OLD SANTA FE TRL
SANTA FE NM
87505-4594
US

IV. Provider business mailing address

7313 OLD SANTA FE TRL
SANTA FE NM
87505-4594
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4190
  • Fax: 505-474-8110
Mailing address:
  • Phone: 505-988-4190
  • Fax: 505-474-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1310
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: