Provider Demographics
NPI:1205259264
Name:LABINE, BRADFORD BLAIR JAMES (DC)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:BLAIR JAMES
Last Name:LABINE
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 1:1732 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3906
Mailing Address - Country:US
Mailing Address - Phone:508-379-9897
Mailing Address - Fax:
Practice Address - Street 1:1732 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3906
Practice Address - Country:US
Practice Address - Phone:508-379-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor