Provider Demographics
NPI:1447385059
Name:REIBLY, JON E (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:REIBLY
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 1:210 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1620
Mailing Address - Country:US
Mailing Address - Phone:765-473-8824
Mailing Address - Fax:765-473-8825
Practice Address - Street 1:210 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1620
Practice Address - Country:US
Practice Address - Phone:765-473-8824
Practice Address - Fax:765-473-8825
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001459A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100179590AMedicaid
IN000000184945OtherANTHEM PIN
IN000000184945OtherANTHEM PIN
IN100179590AMedicaid