Provider Demographics
NPI:1982792313
Name:JEFF LABRADO CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:JEFF LABRADO CHIROPRACTIC CORP
Other - Org Name:DYNAMIC FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:P
Authorized Official - Last Name:LABRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-723-4571
Mailing Address - Street 1:1347 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-723-4571
Mailing Address - Fax:209-723-7068
Practice Address - Street 1:1347 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-723-4571
Practice Address - Fax:209-723-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0240690OtherBLUE SHIELD
17413 Y06932Medicare UPIN
DC0240690OtherBLUE SHIELD