Provider Demographics
NPI:1346619020
Name:RIZZO SPINE AND SPORT
Entity Type:Organization
Organization Name:RIZZO SPINE AND SPORT
Other - Org Name:RIZZO SPINE AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-558-9990
Mailing Address - Street 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13320-3729
Mailing Address - Country:US
Mailing Address - Phone:315-558-9990
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE STE 30
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1899
Practice Address - Country:US
Practice Address - Phone:802-447-2110
Practice Address - Fax:802-447-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3968111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty