Provider Demographics
NPI:1033254719
Name:LASKA-KULBA, JUDITH KATHRYN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:KATHRYN
Last Name:LASKA-KULBA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:CONSTANTIA
Mailing Address - State:NY
Mailing Address - Zip Code:13044-2718
Mailing Address - Country:US
Mailing Address - Phone:315-623-7151
Mailing Address - Fax:
Practice Address - Street 1:1497 STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:CONSTANTIA
Practice Address - State:NY
Practice Address - Zip Code:13044-2718
Practice Address - Country:US
Practice Address - Phone:315-623-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3287111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39083BMedicare ID - Type Unspecified