Provider Demographics
NPI:1295003747
Name:BABU, MICHAELA MICHAYLOVA (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:MICHAYLOVA
Last Name:BABU
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 1:2603 S WASHINGTON ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6375
Mailing Address - Country:US
Mailing Address - Phone:331-201-5785
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST STE 140
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6375
Practice Address - Country:US
Practice Address - Phone:331-201-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor