Provider Demographics
NPI:1891932497
Name:KOLBABA, TIMOTHY CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:KOLBABA
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 1:350 W KENSINGTON RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1141
Mailing Address - Country:US
Mailing Address - Phone:847-222-9060
Mailing Address - Fax:847-222-9130
Practice Address - Street 1:350 W KENSINGTON RD
Practice Address - Street 2:STE 102
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1141
Practice Address - Country:US
Practice Address - Phone:847-222-9060
Practice Address - Fax:847-222-9130
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor