Provider Demographics
NPI:1700998481
Name:RIZZO, RENATO DINO (DC)
Entity type:Individual
Prefix:MR
First Name:RENATO
Middle Name:DINO
Last Name:RIZZO
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 1:2827 W ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1970
Mailing Address - Country:US
Mailing Address - Phone:517-787-2288
Mailing Address - Fax:517-787-2288
Practice Address - Street 1:2827 W ARGYLE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1970
Practice Address - Country:US
Practice Address - Phone:517-787-2288
Practice Address - Fax:517-787-2288
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR008798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35180FOtherBLUE CARE NETWORK
MI950C811140OtherBLUE CROSS BLUE SHIELD MI
MIV00025Medicare UPIN
MIP03160001Medicare PIN