Provider Demographics
NPI:1760635064
Name:RIZZO, JUSTIN GEOFFREY (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GEOFFREY
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 1:3 DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1613
Mailing Address - Country:US
Mailing Address - Phone:315-525-9393
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE STE 30
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1899
Practice Address - Country:US
Practice Address - Phone:802-447-2110
Practice Address - Fax:802-447-2115
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011714111N00000X
NC3968111N00000X
VT006.0134120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760635064OtherNPI