Provider Demographics
NPI:1053424390
Name:LUBAN, MICHAEL G (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:LUBAN
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 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 61
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-553-2020
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 61
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-553-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38006666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021642572OtherBCBSI
K21026Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL212289Medicare ID - Type UnspecifiedGROUP NUMBER
U33762Medicare UPIN