Individual provider Active NPI

Andrew Gerard Dibley, D.C.

  • Sports Physician Chiropractor
  • Elkhart, IN
National Provider Identifier
1801927561
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
08001099A Issued in IN
Practice address
1709 E Bristol St
Elkhart, IN 46514-6606
Phone
(574) 264-9174
Fax
(574) 262-4070
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 08001099A IN Primary

Addresses

Primary practice location

1709 E Bristol St
Elkhart, IN 46514-6606

Mailing address

1709 E Bristol St
Elkhart, IN 46514-6606
Phone (574) 264-9174

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081111000551 IN Practitioner - Chiropractic 0941369581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1987
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1709 E Bristol St a
Dibley Chiropractic
Elkhart, IN 46514-6606
Phone (574) 264-9171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08001099AINMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Andrew G. Dibley, D.C., P.C. CurrentSince Oct 9, 1987 Accepting new patients

Locations

1709 E Bristol St
Elkhart, IN 46514
Phone (574) 264-1471

1709 E Bristol St
Ste A
Elkhart, IN 46514
Phone (574) 264-9171

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801927561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465146606",
            "telephone_number": "574-264-9174",
            "fax_number": "574-262-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465146606",
            "telephone_number": "574-264-9174",
            "fax_number": "574-262-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBLEY",
        "first_name": "ANDREW",
        "middle_name": "GERARD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IN",
            "license": "08001099A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.