MEDICARE: FERNANDO G LABRADA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	22746	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467536367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO G LABRADA D.C.

Provider Business Mailing Address
First Line	:	1058 KENDALL DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-4123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1058 KENDALL DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-4123
Country	:	US
Telephone Number	:	909-881-7429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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