Provider Demographics
NPI:1073858874
Name:REIBLY CHIROPRACTIC INC
Entity type:Organization
Organization Name:REIBLY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:REIBLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-473-8824
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-4044
Mailing Address - Country:US
Mailing Address - Phone:765-473-8824
Mailing Address - Fax:765-473-8825
Practice Address - Street 1:210 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1620
Practice Address - Country:US
Practice Address - Phone:765-473-8824
Practice Address - Fax:765-473-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001459A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350055708OtherRAILROAD MEDICARE
IN000000184945OtherANTHEM BC/BS
IN100179590AMedicaid
IN000000184945OtherANTHEM BC/BS