Healthcare Provider Details

I. General information

NPI: 1619023033
Provider Name (Legal Business Name): TRED J RISSACHER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 SE FEDERAL HWY
STUART FL
34994
US

IV. Provider business mailing address

2311 SE FEDERAL HWY
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-8300
  • Fax: 772-219-3303
Mailing address:
  • Phone: 772-219-8300
  • Fax: 772-219-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: