Provider Demographics
NPI:1457538308
Name:RIVERA, RENE LOREDO (DC)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:LOREDO
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 1:81709 DR CARREON BLVD
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5509
Mailing Address - Country:US
Mailing Address - Phone:760-563-1800
Mailing Address - Fax:760-863-1887
Practice Address - Street 1:81709 DR CARREON BLVD
Practice Address - Street 2:SUITE A-5
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5509
Practice Address - Country:US
Practice Address - Phone:760-563-1800
Practice Address - Fax:760-863-1887
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62871Medicare UPIN