Provider Demographics
NPI:1427088327
Name:PIVA, COLLEEN A (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:PIVA
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 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE D-270
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-803-0321
Mailing Address - Fax:925-803-0350
Practice Address - Street 1:11875 DUBLIN BLVD
Practice Address - Street 2:SUITE D-270
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2843
Practice Address - Country:US
Practice Address - Phone:925-803-0321
Practice Address - Fax:925-803-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23430111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0234300Medicare ID - Type Unspecified
CAU93069Medicare UPIN