Provider Demographics
NPI:1922250711
Name:ANDREW G. DIBLEY, D.C., P.C.
Entity Type:Organization
Organization Name:ANDREW G. DIBLEY, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:574-264-9174
Mailing Address - Street 1:1709 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-6606
Mailing Address - Country:US
Mailing Address - Phone:574-264-9174
Mailing Address - Fax:574-262-4070
Practice Address - Street 1:1709 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-6606
Practice Address - Country:US
Practice Address - Phone:574-264-9174
Practice Address - Fax:574-262-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350055661Medicaid
IN227000Medicare UPIN