Provider Demographics
NPI:1902924723
Name:DRIBNAK, KIP ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:ANDREW
Last Name:DRIBNAK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 E WISTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8774
Mailing Address - Country:US
Mailing Address - Phone:208-461-1121
Mailing Address - Fax:
Practice Address - Street 1:230 W MALLARD DR STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3995
Practice Address - Country:US
Practice Address - Phone:208-422-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer