Provider Demographics
NPI:1073692976
Name:RIVERVIEW CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:RIVERVIEW CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:KAKAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-1512
Mailing Address - Street 1:822 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5729
Mailing Address - Country:US
Mailing Address - Phone:563-242-1512
Mailing Address - Fax:
Practice Address - Street 1:822 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5729
Practice Address - Country:US
Practice Address - Phone:563-242-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU95738Medicare UPIN