Provider Demographics
NPI:1871599654
Name:LAUBACH, ERNEST M (DC)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:M
Last Name:LAUBACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MUNCY
Other - Middle Name:CHIROPRACTIC
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5632 CLARKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-8249
Mailing Address - Country:US
Mailing Address - Phone:570-546-2727
Mailing Address - Fax:570-546-5010
Practice Address - Street 1:5632 CLARKSTOWN RD
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8249
Practice Address - Country:US
Practice Address - Phone:570-546-2727
Practice Address - Fax:570-546-5010
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001368L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068850OtherBLUE SHIELD
PAMU702889Medicare ID - Type Unspecified