Provider Demographics
NPI:1164678157
Name:PETRIZZO, CHRISTOPHER V (DC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:V
Last Name:PETRIZZO
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 1:2104 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3965
Mailing Address - Country:US
Mailing Address - Phone:917-376-6852
Mailing Address - Fax:
Practice Address - Street 1:2104 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3965
Practice Address - Country:US
Practice Address - Phone:917-376-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006619-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06619-3OtherWORKERS COMPENSATION CERTIFICATE OF AUTHORIZATION