Provider Demographics
NPI:1356437933
Name:RIEBELING, DONNA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:RIEBELING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S MARKET
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298
Mailing Address - Country:US
Mailing Address - Phone:618-939-3411
Mailing Address - Fax:618-939-3411
Practice Address - Street 1:110 S MARKET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298
Practice Address - Country:US
Practice Address - Phone:618-939-3411
Practice Address - Fax:618-939-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0678200402OtherBCBS
IL113098OtherHEALTHLINK
IL0678200402OtherBCBS