Provider Demographics
NPI:1093799462
Name:RIZZO, VICTOR JON (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JON
Last Name:RIZZO
Suffix:
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 1:502 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4104
Mailing Address - Country:US
Mailing Address - Phone:814-944-3536
Mailing Address - Fax:814-941-7660
Practice Address - Street 1:502 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4104
Practice Address - Country:US
Practice Address - Phone:814-944-3536
Practice Address - Fax:814-941-7660
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002532L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008908990001Medicaid
PA426316Medicare ID - Type Unspecified
PA0008908990001Medicaid