Provider Demographics
NPI:1881868701
Name:RIVERSIDE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:RIVERSIDE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:D'AQUILA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-433-5559
Mailing Address - Street 1:9 TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-4433
Mailing Address - Country:US
Mailing Address - Phone:401-433-5559
Mailing Address - Fax:
Practice Address - Street 1:9 TURNER AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-4433
Practice Address - Country:US
Practice Address - Phone:401-433-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI359009058Medicare PIN