Provider Demographics
NPI:1881746121
Name:BABIAN, MARY LAVONNE (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LAVONNE
Last Name:BABIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-4629
Mailing Address - Country:US
Mailing Address - Phone:423-877-9733
Mailing Address - Fax:423-870-0956
Practice Address - Street 1:3500 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-4629
Practice Address - Country:US
Practice Address - Phone:423-877-9733
Practice Address - Fax:423-870-0956
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC205111N00000X
GA1291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T74813Medicare UPIN
TN3671782Medicare ID - Type Unspecified