Provider Demographics
NPI:1528225976
Name:DREW TRIBETT, D.C. PC
Entity Type:Organization
Organization Name:DREW TRIBETT, D.C. PC
Other - Org Name:DAVID DREW TRIBETT, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:TRIBETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-755-7654
Mailing Address - Street 1:1300 N 200 E
Mailing Address - Street 2:SUITE #110
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2398
Mailing Address - Country:US
Mailing Address - Phone:435-755-7654
Mailing Address - Fax:435-753-7654
Practice Address - Street 1:1300 N 200 E
Practice Address - Street 2:SUITE #110
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2398
Practice Address - Country:US
Practice Address - Phone:435-755-7654
Practice Address - Fax:435-753-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289256-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT530663408001Medicaid
UTUT03703Medicare UPIN
UT000057945Medicare PIN