Provider Demographics
NPI:1558545368
Name:LABRECQUE FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:LABRECQUE FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRECQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-577-6061
Mailing Address - Street 1:7948 DAVIS BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1903
Mailing Address - Country:US
Mailing Address - Phone:817-577-6061
Mailing Address - Fax:817-577-2345
Practice Address - Street 1:7948 DAVIS BLVD # 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-1903
Practice Address - Country:US
Practice Address - Phone:817-577-6061
Practice Address - Fax:817-577-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00196TOtherMEDICARE GROUP NUMBER
TX8A0166Medicare PIN
TX00196TOtherMEDICARE GROUP NUMBER
TXU95520Medicare UPIN
TXU74469Medicare UPIN