Provider Demographics
NPI:1568944064
Name:RIZZO, GABRIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
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 1:1237 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7443
Mailing Address - Country:US
Mailing Address - Phone:330-931-0770
Mailing Address - Fax:
Practice Address - Street 1:2415 S VOLUSIA AVE STE A2
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7623
Practice Address - Country:US
Practice Address - Phone:386-775-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty