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General NPI Number Information
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NPI Number | 1073858874
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Entity Type | Organization
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Legal Business Name | REIBLY CHIROPRACTIC INC
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 210 BOULEVARD
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City | PERU
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State | IN
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Zip | 46970-1620
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Country | US
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Telephone | 765-473-8824
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Fax | 765-473-8825
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Provider Business Mailing Address
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Address Line | PO BOX 1044
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City | PERU
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State | IN
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Zip | 46970-4044
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Country | US
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Telephone | 765-473-8824
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Fax | 765-473-8825
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | DR. JON E REIBLY
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Credential | D.C.
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Telephone | 765-473-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08001459A
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License Number State | IN
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