Provider Demographics
NPI:1821124702
Name:THUNILJINDA-RIVERA, SIRIKUL RUTH (DC)
Entity Type:Individual
Prefix:
First Name:SIRIKUL
Middle Name:RUTH
Last Name:THUNILJINDA-RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SIRIKUL
Other - Middle Name:RUTH
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:795 SQUIRREL HILL DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5339
Mailing Address - Country:US
Mailing Address - Phone:330-559-1688
Mailing Address - Fax:
Practice Address - Street 1:4495 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-1569
Practice Address - Country:US
Practice Address - Phone:330-782-3190
Practice Address - Fax:330-782-3195
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor