Provider Demographics
NPI:1083826663
Name:RISNER CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RISNER CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-658-6076
Mailing Address - Street 1:9665 FORD AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3652
Mailing Address - Country:US
Mailing Address - Phone:912-445-5607
Mailing Address - Fax:912-756-4726
Practice Address - Street 1:9665 FORD AVE UNIT B
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3652
Practice Address - Country:US
Practice Address - Phone:912-445-5607
Practice Address - Fax:912-756-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU83665Medicare UPIN
GAGRP4655Medicare ID - Type Unspecified