Provider Demographics
NPI:1407998453
Name:KRIEBEL, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:KRIEBEL
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 1:1231 CUMBERLAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1358
Mailing Address - Country:US
Mailing Address - Phone:765-463-7337
Mailing Address - Fax:
Practice Address - Street 1:1231 CUMBERLAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-1358
Practice Address - Country:US
Practice Address - Phone:765-463-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000912A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN805960Medicare ID - Type Unspecified