Provider Demographics
NPI:1417235193
Name:RIST, BRIAN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:RIST
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 1:4155 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2403
Mailing Address - Country:US
Mailing Address - Phone:941-929-0020
Mailing Address - Fax:941-921-7843
Practice Address - Street 1:4155 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2403
Practice Address - Country:US
Practice Address - Phone:941-929-0020
Practice Address - Fax:941-921-7843
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor