Provider Demographics
NPI:1083711550
Name:RIVERS, JULIA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MARIE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51547 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4447
Mailing Address - Country:US
Mailing Address - Phone:586-739-8824
Mailing Address - Fax:586-739-8825
Practice Address - Street 1:51547 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4447
Practice Address - Country:US
Practice Address - Phone:586-739-8824
Practice Address - Fax:586-739-8825
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJR008165Medicare UPIN