Provider Demographics
NPI:1538284658
Name:RIVERA, REYNOL BALDEMAR (DC)
Entity type:Individual
Prefix:DR
First Name:REYNOL
Middle Name:BALDEMAR
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W FERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6177
Mailing Address - Country:US
Mailing Address - Phone:956-292-6557
Mailing Address - Fax:956-686-8069
Practice Address - Street 1:2215 W FERN AVE STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6177
Practice Address - Country:US
Practice Address - Phone:956-292-6557
Practice Address - Fax:956-686-8069
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor