Provider Demographics
NPI:1114398310
Name:BABIARZ, ADAM MICHAEL (DAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:BABIARZ
Suffix:
Gender:M
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3148
Mailing Address - Country:US
Mailing Address - Phone:708-250-4451
Mailing Address - Fax:
Practice Address - Street 1:2105 N 73RD AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3148
Practice Address - Country:US
Practice Address - Phone:708-250-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960050472255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer