Provider Demographics
NPI:1982242186
Name:RISHER, MICHAEL TAL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TAL
Last Name:RISHER
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 1:2236 W CORNELIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6035
Mailing Address - Country:US
Mailing Address - Phone:224-456-7165
Mailing Address - Fax:
Practice Address - Street 1:2378 N ELSTON CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2929
Practice Address - Country:US
Practice Address - Phone:224-456-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor