MEDICARE: DR. TERRY LAUBACH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	DC011323	PA
2	111N00000X	Chiropractor	DC011323	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC011323	OTHER	PA	PENNSYLVANIA STATE CHIROPRACTIC LICENCE

General Provider Information

NPI Number	:	1447765755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY LAUBACH DC

Provider Business Mailing Address
First Line	:	47 MUFFLY LN
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17821-6977
Country	:	US
Telephone Number	:	570-317-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3166 N OLD TRL
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876-9409
Country	:	US
Telephone Number	:	570-743-7833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	06/16/2018

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Directions to “ DR. TERRY LAUBACH DC” Practice Location

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