Provider Demographics
NPI:1982748505
Name:RIVAS, RODOLFO JR (DC)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:RIVAS
Suffix:JR
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 1:405 WINDCHIME PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1984
Mailing Address - Country:US
Mailing Address - Phone:719-598-6955
Mailing Address - Fax:719-598-7157
Practice Address - Street 1:405 WINDCHIME PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1984
Practice Address - Country:US
Practice Address - Phone:719-598-6955
Practice Address - Fax:719-598-7157
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10279111N00000X
COCHR.0008850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor