Provider Demographics
NPI:1891889077
Name:RIBLEY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:RIBLEY CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-479-2700
Mailing Address - Street 1:20960 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9319
Mailing Address - Country:US
Mailing Address - Phone:734-479-2700
Mailing Address - Fax:734-479-5133
Practice Address - Street 1:20960 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-9319
Practice Address - Country:US
Practice Address - Phone:734-479-2700
Practice Address - Fax:734-479-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1369918Medicaid
MI1369918Medicaid