Provider Demographics
NPI:1114364973
Name:NABORCZYK, KEVIN R (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:NABORCZYK
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 1:197 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3147
Mailing Address - Country:US
Mailing Address - Phone:248-590-0253
Mailing Address - Fax:248-590-0254
Practice Address - Street 1:197 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3147
Practice Address - Country:US
Practice Address - Phone:248-590-0253
Practice Address - Fax:248-590-0254
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$OtherSSN