Provider Demographics
NPI:1639220353
Name:KOLBABA, DAVID C (DC, CCN, DACBN)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:KOLBABA
Suffix:
Gender:M
Credentials:DC, CCN, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004839111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3500OtherDIPLOMATE CLINICAL NUTRIT
IL3500OtherDIPLOMATE CLINICAL NUTRIT
ILT38082Medicare UPIN