Provider Demographics
NPI:1699822445
Name:RIVERA, ALICIA A (DC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:A
Other - Last Name:CARDOZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:821 DEBARY AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8805
Mailing Address - Country:US
Mailing Address - Phone:386-860-5448
Mailing Address - Fax:386-668-3665
Practice Address - Street 1:821 DEBARY AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8805
Practice Address - Country:US
Practice Address - Phone:386-860-5448
Practice Address - Fax:386-668-3665
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL316158OtherCHIRO ALLIANCE CORP.
FL381780600Medicaid
FL6265773OtherCIGNA