Provider Demographics
NPI:1235436718
Name:RIVERA, NICOLE CLAIRE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CLAIRE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:#109
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-359-8263
Mailing Address - Fax:732-749-1573
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:#109
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-359-8263
Practice Address - Fax:732-749-1573
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00696800111N00000X, 111NN1001X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine