Provider Demographics
NPI:1679578710
Name:RIBLEY, JAMES P (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
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 1:20960 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9319
Mailing Address - Country:US
Mailing Address - Phone:734-479-2700
Mailing Address - Fax:734-479-5133
Practice Address - Street 1:20960 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-9319
Practice Address - Country:US
Practice Address - Phone:734-479-2700
Practice Address - Fax:734-479-5133
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1369918Medicaid
MI1369918Medicaid