Provider Demographics
NPI:1306138482
Name:PRIBBLE, RYAN WAYNE
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WAYNE
Last Name:PRIBBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:WAYNE
Other - Last Name:PRIBBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 8456
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-8456
Mailing Address - Country:US
Mailing Address - Phone:812-323-7432
Mailing Address - Fax:812-323-7437
Practice Address - Street 1:320 W 8TH ST STE 121
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3745
Practice Address - Country:US
Practice Address - Phone:812-323-7432
Practice Address - Fax:812-323-7437
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002578A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor