Provider Demographics
NPI:1649215021
Name:BULTEMEYER-RIPLEY, TRICIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:A
Last Name:BULTEMEYER-RIPLEY
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 1:10963 VAN WERT DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9211
Mailing Address - Country:US
Mailing Address - Phone:419-238-6686
Mailing Address - Fax:419-238-6201
Practice Address - Street 1:1015 S 11TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2164
Practice Address - Country:US
Practice Address - Phone:260-728-4194
Practice Address - Fax:260-728-4195
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3699111N00000X
IN08002260A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2656308Medicaid
OH9312811OtherPTAN
IN200811680Medicaid
IN221280OtherPTAN
INV10646Medicare UPIN
IN221280OtherPTAN
IN200811680Medicaid