Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | DC005143L | PA |
Y | 111NR0400X | Rehabilitation Chiropractor | DC005143L | PA |
NPI | 1487748653 |
---|---|
Provider Name | Dr. John M Rizzo |
First Address | Ebensburg, PA 15931-1119 |
Second Address | Ebensburg, PA 15931-1119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 01/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0013048330002 | (05) | PA |
192690 | HIGHMARK (01) | PA |
U36982 | (02) | PA |