Individual provider Active NPI

Brandon Keith Riebling, D.C.

  • Chiropractor
  • Meridian, ID
National Provider Identifier
1063866895
Registry record updated Nov 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1928 Issued in ID
Practice address
2857 S. Meridian Rd
Suite 100
Meridian, ID 83642
Phone
(208) 888-5858
Fax
(208) 884-1508
NPI assigned
Apr 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 60636706 WA
Chiropractor 111N00000X CHIA-1928 ID Primary

Addresses

Primary practice location

2857 S. Meridian Rd
Suite 100
Meridian, ID 83642

Mailing address

2857 S. Meridian Rd
Suite 100
Meridian, ID 83642
Phone (208) 888-5858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190510002081 ID Practitioner - Chiropractic 8527359835 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIA-1928IDMDChiropractor
CH 60636706WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Meridian Chiropractic Clinic LLC Chiropractor CurrentSince Nov 24, 2019 Accepting new patients
Struble Chiropractic Inc Chiropractor CurrentSince May 8, 2023 Accepting new patients

Locations

1675 N Maple Grove Rd
Boise, ID 83704
Phone (208) 376-4940

2857 S Meridian Rd
#100
Meridian, ID 83642
Phone (208) 888-5858

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1063866895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2857 S. MERIDIAN RD",
            "address_2": "SUITE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-888-5858",
            "fax_number": "208-884-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2857 S. MERIDIAN RD",
            "address_2": "SUITE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-888-5858",
            "fax_number": "208-884-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEBLING",
        "first_name": "BRANDON",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH 60636706",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.