Provider Demographics
NPI:1578232179
Name:KARBAN, ALEXANDER MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:KARBAN
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 1:6460 DOUBLE EAGLE DR UNIT 608
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1663
Mailing Address - Country:US
Mailing Address - Phone:630-649-2657
Mailing Address - Fax:
Practice Address - Street 1:11422 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4120
Practice Address - Country:US
Practice Address - Phone:773-941-8276
Practice Address - Fax:708-377-5704
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780116780OtherDC
IL1700182243OtherDC