Provider Demographics
NPI:1578544375
Name:LABUE, BRAD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALAN
Last Name:LABUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MCCRACKEN RUN RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3634
Mailing Address - Country:US
Mailing Address - Phone:814-375-8900
Mailing Address - Fax:814-375-8901
Practice Address - Street 1:200 MCCRACKEN RUN RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3634
Practice Address - Country:US
Practice Address - Phone:814-375-8900
Practice Address - Fax:814-375-8901
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005325L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432833Medicaid
PA33454OtherGEISENGER HEALTH PLAN
PA000142625OtherPA. BLUE SHIELD (INDIV)
350032372Medicare ID - Type UnspecifiedMEDICARE RAILROAD CARRIER
PA000142625OtherPA. BLUE SHIELD (INDIV)
PALA-142625Medicare ID - Type Unspecified