Provider Demographics
NPI:1316083587
Name:GRIBLER, KIRK G (DC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:G
Last Name:GRIBLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2120
Mailing Address - Country:US
Mailing Address - Phone:217-222-7983
Mailing Address - Fax:217-223-2906
Practice Address - Street 1:1806 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2120
Practice Address - Country:US
Practice Address - Phone:217-222-7983
Practice Address - Fax:217-223-2906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27565Medicare ID - Type Unspecified