Provider Demographics
NPI:1104834803
Name:LARIVEE, GREGORY L (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:LARIVEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6847
Mailing Address - Country:US
Mailing Address - Phone:561-747-7707
Mailing Address - Fax:561-748-5502
Practice Address - Street 1:920 W INDIANTOWN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6847
Practice Address - Country:US
Practice Address - Phone:561-747-7707
Practice Address - Fax:561-748-5502
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89781ZMedicare ID - Type Unspecified