Provider Demographics
NPI:1376069849
Name:RIVERS TRIBE CORP
Entity Type:Organization
Organization Name:RIVERS TRIBE CORP
Other - Org Name:OMEGA FUNCTIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-667-3650
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80001-0501
Mailing Address - Country:US
Mailing Address - Phone:720-667-3650
Mailing Address - Fax:
Practice Address - Street 1:6650 W 44TH AVE STE 2B
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4711
Practice Address - Country:US
Practice Address - Phone:720-667-3650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR.0007649OtherLICENSE NUMBER FOR LYNN TRAN
COCHR.0007574OtherSTATE LICENSE NUMBER FOR SAMUEL MCDONALD