Provider Demographics
NPI:1518919877
Name:LABO, HEIDI M (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:LABO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:RATCLIFFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2300 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3010
Mailing Address - Country:US
Mailing Address - Phone:313-565-4500
Mailing Address - Fax:313-561-7147
Practice Address - Street 1:2300 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3010
Practice Address - Country:US
Practice Address - Phone:313-565-4500
Practice Address - Fax:313-561-7147
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23-01-007752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14-4752077Medicaid
MI0H20048OtherBCBS
MIQMXPR0033131Medicaid
MI14-4752077Medicaid