Provider Demographics
NPI:1679027098
Name:RIVERA, PAULA (DC, LMT)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1517
Mailing Address - Country:US
Mailing Address - Phone:503-200-8331
Mailing Address - Fax:971-228-5438
Practice Address - Street 1:8196 SW HALL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4676
Practice Address - Country:US
Practice Address - Phone:971-354-6916
Practice Address - Fax:971-228-5438
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22330225700000X
OR5768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist