MEDICARE: HEIDI M LABO DC PC

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	2301007752	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0P08930	OTHER	MI	P-TAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629267083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEIDI M LABO DC PC

Provider Business Mailing Address
First Line	:	1952 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-565-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-565-4500
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. HEIDI MARGUERITE LABO
Credential	:	D.C.
Telephone Number	:	313-565-4500

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	08/12/2013

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