Provider Demographics
NPI:1851937510
Name:RIVAS, ANGEL (DC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3667
Mailing Address - Country:US
Mailing Address - Phone:972-436-9785
Mailing Address - Fax:972-436-6068
Practice Address - Street 1:571 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3667
Practice Address - Country:US
Practice Address - Phone:972-436-9785
Practice Address - Fax:972-436-6068
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14256OtherTX LICENSE