Provider Demographics
NPI:1366043978
Name:RIOS, JESUS (DC)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5860 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5011
Mailing Address - Country:US
Mailing Address - Phone:407-790-4745
Mailing Address - Fax:
Practice Address - Street 1:5860 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5011
Practice Address - Country:US
Practice Address - Phone:407-790-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor