Provider Demographics
NPI:1083919724
Name:LANGE, ANDREA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:LANGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:NOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16535 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5936
Mailing Address - Country:US
Mailing Address - Phone:262-754-4910
Mailing Address - Fax:262-754-4913
Practice Address - Street 1:16535 W BLUEMOUND RD
Practice Address - Street 2:SUITE 222
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5936
Practice Address - Country:US
Practice Address - Phone:262-754-4910
Practice Address - Fax:262-754-4913
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4626-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor