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General NPI Number Information
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NPI Number | 1861681207
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Entity Type | Organization
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Legal Business Name | M-LAB ENTERPRISES,LTD.
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 2 TERMIANL DR. STE. 15
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City | EAST ALTON
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State | IL
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Zip | 62024
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Country | US
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Telephone | 618-258-8610
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Fax | 618-258-8615
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Provider Business Mailing Address
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Address Line | 2 TERMINAL DR STE 15
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City | EAST ALTON
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State | IL
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Zip | 62024-2268
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Country | US
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Telephone | 618-258-8610
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Fax | 618-258-8615
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW E. LABERTEW
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Credential | D.C.
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Telephone | 618-283-2230
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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 | 038008755
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License Number State | IL
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