Provider Demographics
NPI:1720571508
Name:RIGHTEOUS RIVERS LLC
Entity Type:Organization
Organization Name:RIGHTEOUS RIVERS LLC
Other - Org Name:PHOENIX CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDJAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-871-2883
Mailing Address - Street 1:6050 PEACHTREE PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6050 PEACHTREE PKWY STE 420
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3362
Practice Address - Country:US
Practice Address - Phone:770-744-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty