Provider Demographics
NPI:1992996797
Name:KOLBUS, DEREK LOWELL (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LOWELL
Last Name:KOLBUS
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 1:126 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1122
Mailing Address - Country:US
Mailing Address - Phone:906-202-2793
Mailing Address - Fax:
Practice Address - Street 1:126 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1122
Practice Address - Country:US
Practice Address - Phone:906-202-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor