Provider Demographics
NPI:1881766376
Name:RIZZUTO, DOMENICK J (DC)
Entity type:Individual
Prefix:DR
First Name:DOMENICK
Middle Name:J
Last Name:RIZZUTO
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 1:1441 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3425
Mailing Address - Country:US
Mailing Address - Phone:518-482-7164
Mailing Address - Fax:518-482-7164
Practice Address - Street 1:1441 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3425
Practice Address - Country:US
Practice Address - Phone:518-482-7164
Practice Address - Fax:518-482-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50302BMedicare ID - Type Unspecified