Healthcare Provider Details

I. General information

NPI: 1124029483
Provider Name (Legal Business Name): RICHARD JOHN THOMAS LABARBERA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 FRANKLIN ST SUITE 204
ROCKY MOUNT VA
24151-1280
US

IV. Provider business mailing address

1035 FRANKLIN ST SUITE 204
ROCKY MOUNT VA
24151-1280
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-1811
  • Fax: 540-484-1538
Mailing address:
  • Phone: 540-483-1811
  • Fax: 540-484-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: