Provider Demographics
NPI:1679674485
Name:RIBAKOVE, DAVID LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:RIBAKOVE
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 1:4446 MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4446 MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4406
Practice Address - Country:US
Practice Address - Phone:716-877-5800
Practice Address - Fax:716-877-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240511Medicare PIN
445552Medicare UPIN