MEDICARE: DR. ZECHARIAH RIVIETZ DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	CH6846	FL
2	111NN0400X	Neurology Chiropractor	X009571-1	NY

General Provider Information

NPI Number	:	1487893293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZECHARIAH RIVIETZ DC

Provider Business Mailing Address
First Line	:	173 E 74TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3208
Country	:	US
Telephone Number	:	516-480-2936
Fax Number	:	631-231-5201

Provider Business Practice Location Address
First Line	:	173 E 74TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3208
Country	:	US
Telephone Number	:	516-480-2936
Fax Number	:	631-231-5201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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