Provider Demographics
NPI:1861681207
Name:M-LAB ENTERPRISES,LTD.
Entity Type:Organization
Organization Name:M-LAB ENTERPRISES,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:LABERTEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-283-2230
Mailing Address - Street 1:2 TERMINAL DR STE 15
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2268
Mailing Address - Country:US
Mailing Address - Phone:618-258-8610
Mailing Address - Fax:618-258-8615
Practice Address - Street 1:2 TERMIANL DR. STE. 15
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024
Practice Address - Country:US
Practice Address - Phone:618-258-8610
Practice Address - Fax:618-258-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008755Medicaid
IL212232Medicare PIN