Provider Demographics
NPI:1740259092
Name:LABELLE, SHAWN (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:LABELLE
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 1:1152B HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2289
Mailing Address - Country:US
Mailing Address - Phone:864-234-5678
Mailing Address - Fax:864-286-9865
Practice Address - Street 1:1152B HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2289
Practice Address - Country:US
Practice Address - Phone:864-234-5678
Practice Address - Fax:864-286-9865
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ24286Medicare ID - Type Unspecified