Provider Demographics
NPI:1275709156
Name:STANMORE G LANGFORD III DC A CHIROPRACTIC PROF CORPORATION
Entity Type:Organization
Organization Name:STANMORE G LANGFORD III DC A CHIROPRACTIC PROF CORPORATION
Other - Org Name:LANGFORD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANMORE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:619-585-3611
Mailing Address - Street 1:4360 MAIN STREET
Mailing Address - Street 2:STE 209
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6575
Mailing Address - Country:US
Mailing Address - Phone:619-585-3611
Mailing Address - Fax:619-585-3469
Practice Address - Street 1:4360 MAIN STREET
Practice Address - Street 2:STE 209
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6575
Practice Address - Country:US
Practice Address - Phone:619-585-3611
Practice Address - Fax:619-585-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18388Medicare UPIN