Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 222003 | UT |
NPI | 1679660542 |
---|---|
Provider Name | Dr. I Clark Labrum |
First Address | St George, UT 84770-3348 |
Second Address | St George, UT 84770-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 10/10/2011 |