Provider Demographics
NPI:1912129255
Name:RIVERA, WILLIAM NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NICHOLAS
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 1:7706 W HILLSBOROUGH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4723
Mailing Address - Country:US
Mailing Address - Phone:813-882-0833
Mailing Address - Fax:813-882-0830
Practice Address - Street 1:7706 W HILLSBOROUGH AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4723
Practice Address - Country:US
Practice Address - Phone:813-882-0833
Practice Address - Fax:813-882-0830
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH7950OtherMEDICAL LICENSE