Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH12675 | FL |
N | 111NN0400X | Neurology | CH12675 | FL |
NPI | 1063984128 |
---|---|
Provider Name | Dr. Christopher Robert Ristuccia |
First Address | Daytona Beach, FL 32117-5169 |
Second Address | Daytona Beach, FL 32117-5169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2018 |
Last Update Date | 26/01/2021 |