Provider Demographics
NPI:1164432894
Name:RIVERA, ALEJANDRO XAVIER (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:XAVIER
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:XAVIER
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:14441 MEMORIAL DR
Mailing Address - Street 2:SUITE 25
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6744
Mailing Address - Country:US
Mailing Address - Phone:713-777-6677
Mailing Address - Fax:713-621-9856
Practice Address - Street 1:14441 MEMORIAL DR
Practice Address - Street 2:SUITE 25
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6744
Practice Address - Country:US
Practice Address - Phone:713-777-6677
Practice Address - Fax:713-621-9856
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M6600OtherBLUE CROSS BLUE SHIELD
TX8B5695Medicare ID - Type Unspecified
TXU99019Medicare UPIN