Provider Demographics
NPI:1801955760
Name:LOBACZ, ANDREW DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:LOBACZ
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 1:1211 TUTOR LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9115
Mailing Address - Country:US
Mailing Address - Phone:812-476-2225
Mailing Address - Fax:812-476-2225
Practice Address - Street 1:1211 TUTOR LN
Practice Address - Street 2:SUITE F
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9115
Practice Address - Country:US
Practice Address - Phone:812-476-2225
Practice Address - Fax:812-476-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002235A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383696Medicare UPIN
INV05077Medicare ID - Type UnspecifiedUSER PIN