Provider Demographics
NPI:1699702589
Name:LABERTEW, MATTHEW EARL (DC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EARL
Last Name:LABERTEW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NEW YORK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1044
Mailing Address - Country:US
Mailing Address - Phone:618-283-2230
Mailing Address - Fax:618-283-1868
Practice Address - Street 1:825 NEW YORK DR STE 1
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1044
Practice Address - Country:US
Practice Address - Phone:618-283-2230
Practice Address - Fax:618-283-1868
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL416040OtherHEALTHLINK
IL7815199OtherAETNA
IL6025820OtherBCBS
IL038008755Medicaid
IL7815199OtherAETNA
IL416040OtherHEALTHLINK