Provider Demographics
NPI:1144792789
Name:100 PERCENT CHIROPRACTIC RIBLEY, LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC RIBLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-630-4936
Mailing Address - Street 1:9266 KNOX BRIDGE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9266 KNOX BRIDGE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4627
Practice Address - Country:US
Practice Address - Phone:734-673-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty