Provider Demographics
NPI:1457465288
Name:LANG, JAY K (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:K
Last Name:LANG
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 1:413 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-828-4418
Mailing Address - Fax:218-828-4575
Practice Address - Street 1:413 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-828-4418
Practice Address - Fax:218-828-4575
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN778527500Medicaid
6C186LAOtherBCBS
350041435OtherMEDICARE RR
350041435OtherMEDICARE RR