Provider Demographics
NPI:1063866895
Name:RIEBLING, BRANDON KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KEITH
Last Name:RIEBLING
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 1:2857 S. MERIDIAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-888-5858
Mailing Address - Fax:208-884-1508
Practice Address - Street 1:2857 S. MERIDIAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-888-5858
Practice Address - Fax:208-884-1508
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60636706111N00000X
IDCHIA-1928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor