Provider Demographics
NPI:1114657624
Name:RIVERA, JOSE SAMUEL (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:SAMUEL
Last Name:RIVERA
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 1:406 CHARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4785
Mailing Address - Country:US
Mailing Address - Phone:787-356-6072
Mailing Address - Fax:864-801-1470
Practice Address - Street 1:606 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1448
Practice Address - Country:US
Practice Address - Phone:864-848-3912
Practice Address - Fax:864-801-1470
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor