Healthcare Provider Details

I. General information

NPI: 1568944064
Provider Name (Legal Business Name): GABRIEL RIZZO DC, CFMP, ABAAHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 INDUSTRIAL DR
CRESTVIEW FL
32539-8950
US

IV. Provider business mailing address

1133 INDUSTRIAL DR
CRESTVIEW FL
32539-8950
US

V. Phone/Fax

Practice location:
  • Phone: 870-623-4958
  • Fax: 850-331-6425
Mailing address:
  • Phone: 870-623-4958
  • Fax: 850-331-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12562
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number12562
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number12562
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number12562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: