Provider Demographics
NPI:1225841554
Name:KIELBASA, JOHN ANDREW (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:KIELBASA
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 1:5974 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4916
Mailing Address - Country:US
Mailing Address - Phone:219-614-2055
Mailing Address - Fax:
Practice Address - Street 1:7822 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-2468
Practice Address - Country:US
Practice Address - Phone:219-962-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003499A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor