Provider Demographics
NPI:1255401097
Name:LABACH, JONATHAN FRANK (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:FRANK
Last Name:LABACH
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 1:2226 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1390
Mailing Address - Country:US
Mailing Address - Phone:724-816-5739
Mailing Address - Fax:724-940-0292
Practice Address - Street 1:2226 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1390
Practice Address - Country:US
Practice Address - Phone:724-816-5139
Practice Address - Fax:724-940-0292
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
432379OtherHEALTH ASSURANCE
092224Medicare ID - Type Unspecified
432379OtherHEALTH ASSURANCE