Provider Demographics
NPI:1649455338
Name:RIVAS-CASTRO, VIRGINIA ANN (DC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:RIVAS-CASTRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1926
Mailing Address - Country:US
Mailing Address - Phone:715-379-2587
Mailing Address - Fax:
Practice Address - Street 1:1020 MARIE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-1926
Practice Address - Country:US
Practice Address - Phone:715-379-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor