Provider Demographics
NPI:1861060550
Name:100 CHIROPRACTIC LABAU, INC
Entity type:Organization
Organization Name:100 CHIROPRACTIC LABAU, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIRORPACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-539-9308
Mailing Address - Street 1:25005 BLUE RAVINE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5706
Mailing Address - Country:US
Mailing Address - Phone:916-539-9308
Mailing Address - Fax:
Practice Address - Street 1:25005 BLUE RAVINE RD STE 130
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5706
Practice Address - Country:US
Practice Address - Phone:916-539-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty