Provider Demographics
NPI:1467682757
Name:RIVERA, ANDREW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
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 1:267 BROOKLYN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18404
Mailing Address - Country:US
Mailing Address - Phone:570-282-1240
Mailing Address - Fax:570-282-7937
Practice Address - Street 1:267 BROOKLYN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18404
Practice Address - Country:US
Practice Address - Phone:570-282-1240
Practice Address - Fax:570-282-7937
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor