Individual
DR. MARTIN JOHN LABUDA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
3832 N BROADWAY ST, CHICAGO, IL 60613-3218
(773) 296-2225
(773) 296-0731
Mailing address
3832 N BROADWAY ST, CHICAGO, IL 60613-3218
(773) 296-2225
(773) 296-0731
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009597
IL
111NS0005X
Sports Physician Chiropractor
038-009597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632439
BLUE CROSS BLUE SHIELD #
IL
01
—
4063763
CIGNA PIN
IL
01
—
IL7546001
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
03/21/2007
Last updated
07/13/2016
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