Provider Demographics
NPI:1396916896
Name:RISSER, BETH A (DC)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:RISSER
Suffix:
Gender:F
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:P.O. BOX 124
Mailing Address - Street 2:
Mailing Address - City:BART
Mailing Address - State:PA
Mailing Address - Zip Code:17503
Mailing Address - Country:US
Mailing Address - Phone:717-806-5329
Mailing Address - Fax:717-806-5117
Practice Address - Street 1:18C FURNACE RD
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566
Practice Address - Country:US
Practice Address - Phone:717-806-5329
Practice Address - Fax:717-806-5117
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004536L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU11275Medicare UPIN