Provider Demographics
NPI:1841013836
Name:IONTA, RIVER CARLILE (DC)
Entity type:Individual
Prefix:DR
First Name:RIVER
Middle Name:CARLILE
Last Name:IONTA
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 1:268 W FERRY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1817
Mailing Address - Country:US
Mailing Address - Phone:607-483-2161
Mailing Address - Fax:
Practice Address - Street 1:1134 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1671
Practice Address - Country:US
Practice Address - Phone:607-483-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor