Provider Demographics
NPI:1679660542
Name:LABRUM, I CLARK (DC)
Entity Type:Individual
Prefix:DR
First Name:I
Middle Name:CLARK
Last Name:LABRUM
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 1:415 W TABERNACLE ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3348
Mailing Address - Country:US
Mailing Address - Phone:435-673-2700
Mailing Address - Fax:435-673-2714
Practice Address - Street 1:415 W TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3348
Practice Address - Country:US
Practice Address - Phone:435-673-2700
Practice Address - Fax:435-673-2714
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT222003111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5724Medicare ID - Type Unspecified