Provider Demographics
NPI:1659800886
Name:LABABIDI, AJ (DC)
Entity Type:Individual
Prefix:
First Name:AJ
Middle Name:
Last Name:LABABIDI
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 1:15680 HIGH KNOLL DR UNIT 217
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3899
Mailing Address - Country:US
Mailing Address - Phone:714-655-6238
Mailing Address - Fax:
Practice Address - Street 1:3560 GRAND AVE STE M
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5406
Practice Address - Country:US
Practice Address - Phone:909-315-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty