Provider Demographics
NPI:1285772830
Name:RIZZI, LEO (DC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:RIZZI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEONARD
Other - Middle Name:
Other - Last Name:RIZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:355 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1471
Mailing Address - Country:US
Mailing Address - Phone:909-593-6553
Mailing Address - Fax:909-593-1084
Practice Address - Street 1:355 E FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1471
Practice Address - Country:US
Practice Address - Phone:909-593-6553
Practice Address - Fax:909-593-1084
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16830Medicare PIN