Provider Demographics
NPI:1124186549
Name:KREIBICH, JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KREIBICH
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 1:1740 WEIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-702-6900
Mailing Address - Fax:651-702-6916
Practice Address - Street 1:1740 WEIR DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-702-6900
Practice Address - Fax:651-702-6916
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4030111N00000X
WI4241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor