Provider Demographics
NPI:1922007376
Name:PREBISH, RICHARD G (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:PREBISH
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 1:310 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-8680
Mailing Address - Country:US
Mailing Address - Phone:269-965-3367
Mailing Address - Fax:269-965-5753
Practice Address - Street 1:310 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-8680
Practice Address - Country:US
Practice Address - Phone:269-965-3367
Practice Address - Fax:269-965-5753
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4430003OtherIBA/PHP
MI0N83750Medicare ID - Type Unspecified
MI4430003OtherIBA/PHP