Provider Demographics
NPI:1083662993
Name:KRIZ, JOANIELEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:JOANIELEE
Middle Name:
Last Name:KRIZ
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 1:5606 RIVER OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-268-1999
Mailing Address - Fax:321-264-2440
Practice Address - Street 1:2203 GARDEN STREET
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-269-1999
Practice Address - Fax:321-264-2440
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381582000Medicaid
FLU92420Medicare UPIN
FL70069ZMedicare ID - Type Unspecified