Provider Demographics
NPI:1427419704
Name:FIEBIG, RYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYNE
Middle Name:
Last Name:FIEBIG
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 1:15729 LOS GATOS BLVD
Mailing Address - Street 2:#100
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2555
Mailing Address - Country:US
Mailing Address - Phone:408-358-7900
Mailing Address - Fax:408-359-4020
Practice Address - Street 1:15729 LOS GATOS BLVD
Practice Address - Street 2:#100
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2555
Practice Address - Country:US
Practice Address - Phone:408-358-7900
Practice Address - Fax:408-359-4020
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33509111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician