Provider Demographics
NPI:1558966333
Name:RIZKALLAH, ANTONY GEORGES (DC)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:GEORGES
Last Name:RIZKALLAH
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 1:4122 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2905
Mailing Address - Country:US
Mailing Address - Phone:714-760-6365
Mailing Address - Fax:
Practice Address - Street 1:4122 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2905
Practice Address - Country:US
Practice Address - Phone:714-760-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor