Provider Demographics
NPI:1750489936
Name:KRIBS, JOHN DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:KRIBS
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:MI
Mailing Address - Zip Code:49251-0515
Mailing Address - Country:US
Mailing Address - Phone:517-589-5610
Mailing Address - Fax:517-589-9908
Practice Address - Street 1:522 W BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:MI
Practice Address - Zip Code:49251-9490
Practice Address - Country:US
Practice Address - Phone:517-589-5610
Practice Address - Fax:517-589-9908
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3040387Medicaid
MI201140961OtherCOMMERCIAL
MI950C312580OtherBLUE CROSS/BLUE SHIELD ID
MI0P03330Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MI3040387Medicaid