Provider Demographics
NPI:1336390830
Name:RIVERVIEW CHIROPRACTIC INC
Entity Type:Organization
Organization Name:RIVERVIEW CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-643-2211
Mailing Address - Street 1:1466 RIVERSIDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-4323
Mailing Address - Country:US
Mailing Address - Phone:423-643-2211
Mailing Address - Fax:423-643-2210
Practice Address - Street 1:1466 RIVERSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-4323
Practice Address - Country:US
Practice Address - Phone:423-643-2211
Practice Address - Fax:423-643-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU87569Medicare UPIN