Provider Demographics
NPI:1447765755
Name:LAUBACH, TERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
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 1:47 MUFFLY LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-6977
Mailing Address - Country:US
Mailing Address - Phone:570-317-7875
Mailing Address - Fax:
Practice Address - Street 1:3166 N OLD TRL
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9409
Practice Address - Country:US
Practice Address - Phone:570-743-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011323111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC011323OtherPENNSYLVANIA STATE CHIROPRACTIC LICENCE