Provider Demographics
NPI:1629757786
Name:DIAZ RIVERA, JENNIFER (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DIAZ RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 OREGON PIKE STE A104
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4206
Mailing Address - Country:US
Mailing Address - Phone:787-648-8617
Mailing Address - Fax:
Practice Address - Street 1:1725 OREGON PIKE STE A104
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4206
Practice Address - Country:US
Practice Address - Phone:787-648-8617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor