Provider Demographics
NPI:1508213521
Name:LA GRANGE, CHERYL ANNE (DC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:LA GRANGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:ME
Mailing Address - Zip Code:04419-3528
Mailing Address - Country:US
Mailing Address - Phone:207-631-1057
Mailing Address - Fax:
Practice Address - Street 1:992 HAMPDEN RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:ME
Practice Address - Zip Code:04419-3528
Practice Address - Country:US
Practice Address - Phone:207-631-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor