=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992999288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABARRE CHIROPRACTIC HEALTH CENTER P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2007
-----------------------------------------------------
Last Update Date | 06/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1843 NORTHAMPTON ST
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-253-9394
-----------------------------------------------------
Fax | 610-253-9457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1843 NORTHAMPTON ST
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-253-9394
-----------------------------------------------------
Fax | 610-253-9457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MATTHEW LABARRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-253-9394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC1055L DC006980L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------