=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932395837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVANO CHIROPRACTIC HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2007
-----------------------------------------------------
Last Update Date | 09/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 COLUMBIA TPKE SUITE 301
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-845-6282
-----------------------------------------------------
Fax | 973-845-6283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 COLUMBIA TURNPIKE SUITE 301
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-845-6282
-----------------------------------------------------
Fax | 973-845-6283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPERATOR
-----------------------------------------------------
Name | DR. ANTHONY RIVANO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 973-845-6282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00657000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------