Provider Demographics
NPI:1083769954
Name:RISTY, EMILY KATHRYN (DC)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATHRYN
Last Name:RISTY
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 1:1829 NEBRASKA AVE
Mailing Address - Street 2:BALANCEPOINT HEALTH CENTER, PC
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-476-1116
Mailing Address - Fax:541-476-1720
Practice Address - Street 1:1829 NEBRASKA AVE
Practice Address - Street 2:BALANCEPOINT HEALTH CENTER, PC
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-476-1116
Practice Address - Fax:541-476-1720
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR131383Medicare ID - Type Unspecified