Healthcare Provider Details

I. General information

NPI: 1598205379
Provider Name (Legal Business Name): MIGUEL RIVERA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-3738
US

IV. Provider business mailing address

572 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-3738
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-2944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0623
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: