Provider Demographics
NPI:1962424978
Name:RIBASTE, ANGELA (DC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:RIBASTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 NALL AVE., STE 202
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4550
Mailing Address - Country:US
Mailing Address - Phone:913-948-6602
Mailing Address - Fax:913-948-6603
Practice Address - Street 1:9401 NALL AVE., STE 202
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-4550
Practice Address - Country:US
Practice Address - Phone:913-948-6602
Practice Address - Fax:913-948-6603
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH48B781Medicare ID - Type Unspecified
KSU90015Medicare UPIN