Provider Demographics
NPI:1437170289
Name:RIEBESELL, ROBERT GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:RIEBESELL
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 1:1001 CROSSPOINTE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-0946
Mailing Address - Country:US
Mailing Address - Phone:239-592-0304
Mailing Address - Fax:239-592-5540
Practice Address - Street 1:1001 CROSSPOINTE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0946
Practice Address - Country:US
Practice Address - Phone:239-592-0304
Practice Address - Fax:239-592-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLCH0004356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0309OtherPTAN
FLQ0309Medicare PIN
FLT44880Medicare UPIN