Provider Demographics
NPI:1649389354
Name:RIZZO, COREY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:JOHN
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 1:5037 GULFWAY DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642
Mailing Address - Country:US
Mailing Address - Phone:409-982-7716
Mailing Address - Fax:409-983-7792
Practice Address - Street 1:5037 GULFWAY DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-982-7716
Practice Address - Fax:409-983-7792
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8276496OtherBLUE LINK
TX606017OtherBCBS LICENSE
TX2275372OtherAETN
TX8325OtherDC LICENSE
TX8325OtherDC LICENSE
TX2275372OtherAETN