Provider Demographics
NPI:1083656169
Name:RIBELLIA, RICHARD LUCIAN (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LUCIAN
Last Name:RIBELLIA
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 1:305 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1719
Mailing Address - Country:US
Mailing Address - Phone:509-766-8428
Mailing Address - Fax:509-766-7327
Practice Address - Street 1:305 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1719
Practice Address - Country:US
Practice Address - Phone:509-766-8428
Practice Address - Fax:509-766-7327
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT41263Medicare UPIN