Provider Demographics
NPI:1235708744
Name:RIVERA MORELL, CORAL DEL MAR (DC)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:DEL MAR
Last Name:RIVERA MORELL
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 1:1354 LOWER HARTLEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-8608
Mailing Address - Country:US
Mailing Address - Phone:787-409-7900
Mailing Address - Fax:
Practice Address - Street 1:1354 LOWER HARTLEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-8608
Practice Address - Country:US
Practice Address - Phone:787-409-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor