Provider Demographics
NPI:1740814292
Name:RIVERA-CRUZ, ERIC YANIEL (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:YANIEL
Last Name:RIVERA-CRUZ
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 1:5721 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5154
Mailing Address - Country:US
Mailing Address - Phone:706-935-7729
Mailing Address - Fax:
Practice Address - Street 1:715 S THORNTON AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8213
Practice Address - Country:US
Practice Address - Phone:706-609-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3273111N00000X
GACHIR010336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor