Provider Demographics
NPI:1144462052
Name:RIVERA, TONI LUISA (DC)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:LUISA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TONI
Other - Middle Name:L
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7313 OLD SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4594
Mailing Address - Country:US
Mailing Address - Phone:505-988-4190
Mailing Address - Fax:505-474-8110
Practice Address - Street 1:7313 OLD SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4594
Practice Address - Country:US
Practice Address - Phone:505-988-4190
Practice Address - Fax:505-474-8110
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor