Provider Demographics
NPI:1437201829
Name:DR. DAVID C. KOLBABA & ASSOCIATES, INC
Entity Type:Organization
Organization Name:DR. DAVID C. KOLBABA & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOLBABA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCN, DACBN
Authorized Official - Phone:847-428-8850
Mailing Address - Street 1:606 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2026
Mailing Address - Country:US
Mailing Address - Phone:847-428-8850
Mailing Address - Fax:847-428-8887
Practice Address - Street 1:606 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2026
Practice Address - Country:US
Practice Address - Phone:847-428-8850
Practice Address - Fax:847-428-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004839111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3500OtherDIPLOMATE CLINCL NUTRITN
IL716850Medicare ID - Type Unspecified
ILT38082Medicare UPIN