Provider Demographics
NPI:1386839611
Name:LANGILLE, TONWEYA WILLOW (DC)
Entity Type:Individual
Prefix:DR
First Name:TONWEYA
Middle Name:WILLOW
Last Name:LANGILLE
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 1:300 W BROADWAY
Mailing Address - Street 2:SUITE 712
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9045
Mailing Address - Country:US
Mailing Address - Phone:712-256-2561
Mailing Address - Fax:712-256-1927
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:SUITE 712
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9030
Practice Address - Country:US
Practice Address - Phone:712-256-2561
Practice Address - Fax:712-256-1927
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6296940001Medicare NSC