Provider Demographics
NPI:1821782749
Name:RIVERA ORTIZ, VICMARIE
Entity Type:Individual
Prefix:
First Name:VICMARIE
Middle Name:
Last Name:RIVERA ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18336 AURORA AVE N STE 111
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4526
Mailing Address - Country:US
Mailing Address - Phone:206-542-3607
Mailing Address - Fax:206-542-3265
Practice Address - Street 1:18336 AURORA AVE N STE 111
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4526
Practice Address - Country:US
Practice Address - Phone:206-542-3607
Practice Address - Fax:206-542-3265
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61427926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor