Provider Demographics
NPI:1295201960
Name:RIVER TREE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RIVER TREE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-940-2255
Mailing Address - Street 1:228 BROOKHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2189
Mailing Address - Country:US
Mailing Address - Phone:770-940-2255
Mailing Address - Fax:
Practice Address - Street 1:4290 BELLS FERRY RD NW STE 118
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1300
Practice Address - Country:US
Practice Address - Phone:770-924-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty