Healthcare Provider Details

I. General information

NPI: 1235571084
Provider Name (Legal Business Name): CHRISTOPHER KUDYBA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 PLAINFIELD NAPERVILLE RD SUITE 105
NAPERVILLE IL
60564-4238
US

IV. Provider business mailing address

4015 PLAINFIELD NAPERVILLE RD SUITE 105
NAPERVILLE IL
60564-4238
US

V. Phone/Fax

Practice location:
  • Phone: 630-904-9700
  • Fax: 630-904-9713
Mailing address:
  • Phone: 630-904-9700
  • Fax: 630-904-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012393
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: