Provider Demographics
NPI:1992409635
Name:RIVERA, JURITZA Y (DC)
Entity type:Individual
Prefix:
First Name:JURITZA
Middle Name:Y
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 1:5977 STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2371
Mailing Address - Country:US
Mailing Address - Phone:770-942-5575
Mailing Address - Fax:470-539-8557
Practice Address - Street 1:5977 STEWART PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2371
Practice Address - Country:US
Practice Address - Phone:770-942-5575
Practice Address - Fax:470-539-8557
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor