Provider Demographics
NPI:1821022252
Name:KOBAN, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:KOBAN
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 1:636 W REPUBLIC RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5818
Mailing Address - Country:US
Mailing Address - Phone:417-862-1922
Mailing Address - Fax:417-862-1923
Practice Address - Street 1:636 W REPUBLIC RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5818
Practice Address - Country:US
Practice Address - Phone:417-862-1922
Practice Address - Fax:417-862-1923
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23033111N00000X
MO2007030726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1209002Medicare PIN