Provider Demographics
NPI:1811914617
Name:PRIBBLE, GARY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:PRIBBLE
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 1:1000 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4400
Mailing Address - Country:US
Mailing Address - Phone:563-355-2378
Mailing Address - Fax:563-355-2378
Practice Address - Street 1:1000 23RD ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4400
Practice Address - Country:US
Practice Address - Phone:563-355-2378
Practice Address - Fax:563-355-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0244004Medicaid
IAI4284Medicare ID - Type Unspecified
IA0244004Medicaid