=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205974599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABBE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4295 GESNER ST STE. 3A
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117-6646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-275-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4295 GESNER ST STE. 3A
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117-6646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-275-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JONI LABBE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 619-275-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC23874
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------