Provider Demographics
NPI:1720280779
Name:MARTIN J. LABUDA, DC, PC
Entity Type:Organization
Organization Name:MARTIN J. LABUDA, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LABUDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:773-296-2225
Mailing Address - Street 1:3832 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3218
Mailing Address - Country:US
Mailing Address - Phone:773-296-2225
Mailing Address - Fax:773-296-0731
Practice Address - Street 1:3832 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3218
Practice Address - Country:US
Practice Address - Phone:773-296-2225
Practice Address - Fax:773-296-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4063763OtherCIGNA
IL01632439OtherBLUE CROSS BLUE SHIELD
ILIL7546OtherMEDICARE PTAN
IL01632439OtherBLUE CROSS BLUE SHIELD
ILIL7546OtherMEDICARE PTAN