Provider Demographics
NPI:1881661932
Name:LAUBACH, KRISTOPHER SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:SHAWN
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 1:111 NEW ST
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-1711
Mailing Address - Country:US
Mailing Address - Phone:570-546-9131
Mailing Address - Fax:
Practice Address - Street 1:5632 CLARKSTOWN RD
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8249
Practice Address - Country:US
Practice Address - Phone:570-546-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1783709Medicare UPIN