Provider Demographics
NPI:1811043276
Name:RIBENBOIM, ERIC LEONARD (DC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEONARD
Last Name:RIBENBOIM
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 1:26 MACK WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1738
Mailing Address - Country:US
Mailing Address - Phone:502-633-1574
Mailing Address - Fax:502-647-9144
Practice Address - Street 1:26 MACK WALTERS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1738
Practice Address - Country:US
Practice Address - Phone:502-633-1574
Practice Address - Fax:502-647-9144
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY4135111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1154468932OtherGROUP NPI
KY85000313Medicaid
KYX53335Medicare UPIN