Provider Demographics
NPI:1194993048
Name:MICHAEL L BELBA DC PC
Entity type:Organization
Organization Name:MICHAEL L BELBA DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BELBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-920-1822
Mailing Address - Street 1:3207 LAKE AVE
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1082
Mailing Address - Country:US
Mailing Address - Phone:847-920-1822
Mailing Address - Fax:847-920-1823
Practice Address - Street 1:3207 LAKE AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1082
Practice Address - Country:US
Practice Address - Phone:847-920-1822
Practice Address - Fax:847-920-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty