Healthcare Provider Details

I. General information

NPI: 1386770980
Provider Name (Legal Business Name): KEN A RIVAS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E MONTICELLO DR
KAYSVILLE UT
84037-2801
US

IV. Provider business mailing address

46 E MONTICELLO DR
KAYSVILLE UT
84037-2801
US

V. Phone/Fax

Practice location:
  • Phone: 801-444-3948
  • Fax:
Mailing address:
  • Phone: 801-444-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number278885-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: