Provider Demographics
NPI:1063429983
Name:RIBAKOVE, TINA LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:LOUISE
Last Name:RIBAKOVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4446 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4406
Mailing Address - Country:US
Mailing Address - Phone:716-877-5800
Mailing Address - Fax:716-877-5801
Practice Address - Street 1:4446 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4406
Practice Address - Country:US
Practice Address - Phone:716-877-5800
Practice Address - Fax:716-877-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0075581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300009032OtherPTAN
NYJ300009032OtherPTAN
U47051Medicare UPIN