Provider Demographics
NPI:1932271558
Name:RIVERA, NIKOLE JOAN (DC)
Entity Type:Individual
Prefix:MISS
First Name:NIKOLE
Middle Name:JOAN
Last Name:RIVERA
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 1:1100 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-590-7036
Mailing Address - Fax:650-593-5071
Practice Address - Street 1:1100 INDUSTRIAL RD
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-593-4447
Practice Address - Fax:650-593-5071
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0287310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U975020Medicare UPIN
CADC0287310Medicare ID - Type Unspecified