Provider Demographics
NPI:1114985827
Name:RIVERA & SANTIAGO S.C
Entity Type:Organization
Organization Name:RIVERA & SANTIAGO S.C
Other - Org Name:NUESTRA CLINICA DE AURORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-802-0124
Mailing Address - Street 1:645 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3546
Mailing Address - Country:US
Mailing Address - Phone:630-375-1604
Mailing Address - Fax:630-375-1608
Practice Address - Street 1:645 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3546
Practice Address - Country:US
Practice Address - Phone:630-375-1604
Practice Address - Fax:630-375-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-618785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213631Medicare PIN