Provider Demographics
NPI:1770694051
Name:KABANCE, JON (RKT)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KABANCE
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:4209 N KEYSTONE AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2318
Mailing Address - Country:US
Mailing Address - Phone:847-804-3311
Mailing Address - Fax:773-409-7710
Practice Address - Street 1:1300 W BELMONT AVE STE 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3242
Practice Address - Country:US
Practice Address - Phone:847-804-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist