| Dr Grant Vidal Rivera, DC | |
|
9864 Rea Rd Ste B, Charlotte, NC 28277-6792 | |
| (980) 339-3058 | |
| Not Available |
| Full Name | Dr Grant Vidal Rivera |
|---|---|
| Gender | Male |
| Speciality | Chiropractor |
| Location | 9864 Rea Rd Ste B, Charlotte, North Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932841376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 36215 (California) | Secondary |
| 111N00000X | Chiropractor | 5665 (North Carolina) | Primary |
| Provider Name | 100 Chiro Padilla 2 Pllc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1932785839 PECOS PAC ID: 0840698395 Enrollment ID: O20211013002590 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Grant Vidal Rivera, DC 6830 Poppy Hills Ln Apt 1235, Charlotte, NC 28226-8563 Ph: (305) 528-5755 | Dr Grant Vidal Rivera, DC 9864 Rea Rd Ste B, Charlotte, NC 28277-6792 Ph: (980) 339-3058 |
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