Provider Demographics
NPI:1760595680
Name:RIVERS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:RIVERS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-739-8824
Mailing Address - Street 1:51547 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4447
Mailing Address - Country:US
Mailing Address - Phone:586-739-8824
Mailing Address - Fax:586-739-8825
Practice Address - Street 1:51547 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-4447
Practice Address - Country:US
Practice Address - Phone:586-739-8824
Practice Address - Fax:586-739-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON73380Medicare PIN
0P35750Medicare PIN