Provider Demographics
NPI:1144786385
Name:LAUBACH, MIKE JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:JACK
Last Name:LAUBACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 BUENA VIS APT E
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5068
Mailing Address - Country:US
Mailing Address - Phone:949-230-7369
Mailing Address - Fax:
Practice Address - Street 1:903 BUENA VIS APT E
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5068
Practice Address - Country:US
Practice Address - Phone:949-230-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor