Provider Demographics
NPI:1407922974
Name:RIVERA, STEVEN S (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:S
Last Name:RIVERA
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 1:2418 MARSH LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:972-478-8500
Mailing Address - Fax:972-478-8501
Practice Address - Street 1:2418 MARSH LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:972-478-8500
Practice Address - Fax:972-478-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606362Medicare ID - Type Unspecified
TX609758Medicare PIN
50290Medicare UPIN