Provider Demographics
NPI:1730571605
Name:RISVOLD, ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:RISVOLD
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 1:5900 PAINTER RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8200
Mailing Address - Country:US
Mailing Address - Phone:612-501-2430
Mailing Address - Fax:
Practice Address - Street 1:126 N 3RD ST
Practice Address - Street 2:504
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1658
Practice Address - Country:US
Practice Address - Phone:612-501-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor