Provider Demographics
NPI:1578744330
Name:VIZZINI CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:VIZZINI CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VIZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-975-9648
Mailing Address - Street 1:1437 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3435
Mailing Address - Country:US
Mailing Address - Phone:478-975-9648
Mailing Address - Fax:478-975-9632
Practice Address - Street 1:1437 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3435
Practice Address - Country:US
Practice Address - Phone:478-975-9648
Practice Address - Fax:478-975-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA739157238AMedicaid