Provider Demographics
NPI:1245400860
Name:RIVERA COLON, JONATHAN D (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:RIVERA COLON
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 1:140 AVE CALDERON
Mailing Address - Street 2:2602 VILLA CAROLINA COURT
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4969
Mailing Address - Country:US
Mailing Address - Phone:787-234-6112
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE MUNOZ RIVERA N
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6068
Practice Address - Country:US
Practice Address - Phone:787-234-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor