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NPI Code Detail

MEDICARE: DR. GRANT VIDAL RIVERA DC

MEDICARE: DR. GRANT VIDAL 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
1111N00000XChiropractor5665NC
2111N00000XChiropractor36215CA

General Provider Information

NPI Number : 1932841376
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRANT VIDAL RIVERA DC
Provider Business Mailing Address
First Line : 10716 CARMEL COMMONS BLVD STE 130
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-3926
Country : US
Telephone Number : 704-610-5366
Fax Number : 704-997-1569
Provider Business Practice Location Address
First Line : 10716 CARMEL COMMONS BLVD STE 130
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-3926
Country : US
Telephone Number : 704-610-5366
Fax Number : 704-997-1569
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2022
Last Update Date : 12/12/2025

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Directions to “ DR. GRANT VIDAL RIVERA DC” Practice Location

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