Provider Demographics
NPI:1023073095
Name:RIBLEY, LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:RIBLEY
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 1:8523 BUCCANEER SQ
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3809
Mailing Address - Country:US
Mailing Address - Phone:813-886-8824
Mailing Address - Fax:813-888-5581
Practice Address - Street 1:8525 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3809
Practice Address - Country:US
Practice Address - Phone:813-886-8824
Practice Address - Fax:813-888-5581
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0007017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380805000Medicaid
FL55320OtherBLUE CROSS BLUE SHIELD
FL55320Medicare PIN
FLU57435Medicare UPIN