Provider Demographics
NPI:1518094614
Name:LANGE, CHARLES HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:LANGE
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:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-0329
Mailing Address - Country:US
Mailing Address - Phone:231-938-8000
Mailing Address - Fax:231-938-0547
Practice Address - Street 1:5152 US 31 N
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49610
Practice Address - Country:US
Practice Address - Phone:231-938-8000
Practice Address - Fax:231-938-0547
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007576111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24030Medicare ID - Type Unspecified