Provider Demographics
NPI:1629267083
Name:HEIDI M LABO DC PC
Entity Type:Organization
Organization Name:HEIDI M LABO DC PC
Other - Org Name:LABO FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MARGUERITE
Authorized Official - Last Name:LABO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-565-4500
Mailing Address - Street 1:1952 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2917
Mailing Address - Country:US
Mailing Address - Phone:313-565-4500
Mailing Address - Fax:
Practice Address - Street 1:1952 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2917
Practice Address - Country:US
Practice Address - Phone:313-565-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P08930OtherP-TAN
MI4752077Medicaid
MI0P08930OtherP-TAN