Provider Demographics
NPI:1679765101
Name:RISNER, GREGG HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:HOWARD
Last Name:RISNER
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 1:300 W. BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494
Mailing Address - Country:US
Mailing Address - Phone:903-342-3113
Mailing Address - Fax:903-342-7734
Practice Address - Street 1:300 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2435
Practice Address - Country:US
Practice Address - Phone:903-342-3113
Practice Address - Fax:903-342-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4288111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4288OtherSTATE LICENSE