Provider Demographics
NPI:1275786642
Name:LABRECHE, PAUL J JR (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:LABRECHE
Suffix:JR
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12806 E 101ST PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4662
Mailing Address - Country:US
Mailing Address - Phone:918-376-4243
Mailing Address - Fax:918-376-4249
Practice Address - Street 1:ELITE PERFORMANCE & REHABILITATION
Practice Address - Street 2:12806 E. 101ST PLACE N.
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-376-4243
Practice Address - Fax:918-376-4249
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11018111N00000X
TX1152378225100000X
OK4574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4079OtherOK CHIROPRACTIC BOARD OF EXAMINERS
OK4574OtherOK MEDICAL BOARD