Provider Demographics
NPI:1346697299
Name:KEVIN R NABORCZYK PLLC
Entity type:Organization
Organization Name:KEVIN R NABORCZYK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NABORCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-590-0253
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty