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General NPI Number Information
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NPI Number | 1417676875
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Entity Type | Individual
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Provider Name | BRIDGET GRACE LABUS DC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 203 PRAIRIE DR
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City | WALWORTH
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State | WI
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Zip | 53184-9795
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Country | US
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Telephone | 415-710-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 203 PRAIRIE DR
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City | WALWORTH
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State | WI
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Zip | 53184-9795
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Country | US
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Telephone | 415-710-4708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6302-12
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License Number State | WI
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