Provider Demographics
NPI:1851430409
Name:RISSACHER, TODD RAYNOR (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RAYNOR
Last Name:RISSACHER
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 1:3215 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4451
Mailing Address - Country:US
Mailing Address - Phone:772-692-7899
Mailing Address - Fax:772-692-7891
Practice Address - Street 1:3215 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4451
Practice Address - Country:US
Practice Address - Phone:772-692-7899
Practice Address - Fax:772-692-7891
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70373OtherBCBS
FL7291OtherCHIROPRACTIC LICENSE #
FL7291OtherCHIROPRACTIC LICENSE #