Provider Demographics
NPI:1841247640
Name:LABELLE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:LABELLE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:V
Authorized Official - Last Name:LABELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-234-5678
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1284Medicaid
SC3704Medicare ID - Type Unspecified
SCCH1284Medicaid