Provider Demographics
NPI:1265738462
Name:RIVERA, PABLO M (DC)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:M
Last Name:RIVERA
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 1:13910 FIVAY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7130
Mailing Address - Country:US
Mailing Address - Phone:813-727-8623
Mailing Address - Fax:727-862-3500
Practice Address - Street 1:13910 FIVAY RD STE 10
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7130
Practice Address - Country:US
Practice Address - Phone:813-727-8623
Practice Address - Fax:727-862-3500
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor