MEDICARE: DR. TIMOTHY CHARLES KOLBABA 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	111N00000X	Chiropractor	038011312	IL

General Provider Information

NPI Number	:	1891932497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY CHARLES KOLBABA DC

Provider Business Mailing Address
First Line	:	350 W KENSINGTON RD
Second Line	:	STE 102
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9060
Fax Number	:	847-222-9130

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD
Second Line	:	STE 102
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9060
Fax Number	:	847-222-9130

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

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	06/10/2016

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