Provider Demographics
NPI:1699881524
Name:LABUS, BRYAN H (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:H
Last Name:LABUS
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 1:4005 GATEWAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5906
Mailing Address - Country:US
Mailing Address - Phone:817-868-0252
Mailing Address - Fax:817-868-0245
Practice Address - Street 1:4005 GATEWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5906
Practice Address - Country:US
Practice Address - Phone:817-868-0252
Practice Address - Fax:817-868-0245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
606401OtherBCBS
TX00313HMedicare PIN