Provider Demographics
NPI:1225100431
Name:RIVERA, JAIME J (DC)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:J
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 1:814 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7120
Mailing Address - Country:US
Mailing Address - Phone:956-412-8551
Mailing Address - Fax:956-412-0573
Practice Address - Street 1:814 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7120
Practice Address - Country:US
Practice Address - Phone:956-412-8551
Practice Address - Fax:956-412-0573
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5999DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0812000-01Medicaid
TX84140FMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX0812000-01Medicaid