MEDICARE: DR. TATIANA RIVERA 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	111N00000X	Chiropractor	13666	FL

General Provider Information

NPI Number	:	1831824564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATIANA RIVERA DC

Provider Business Mailing Address
First Line	:	2575 SANDS DR APT 105
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-3337
Country	:	US
Telephone Number	:	787-643-5195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1438 66TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5504
Country	:	US
Telephone Number	:	727-477-3558
Fax Number	:

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

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	07/18/2022

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