Healthcare Provider Details

I. General information

NPI: 1497892079
Provider Name (Legal Business Name): KRISTIN RIBLEY D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 BUCKHEAD XING STE 130
WOODSTOCK GA
30189-4261
US

IV. Provider business mailing address

1085 BUCKHEAD XING STE 130
WOODSTOCK GA
30189-4261
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-2505
  • Fax: 770-592-2433
Mailing address:
  • Phone: 770-592-2505
  • Fax: 770-592-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: