Provider Demographics
NPI:1518574771
Name:TODD R LANGE DC, PLLC
Entity Type:Organization
Organization Name:TODD R LANGE DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-759-4545
Mailing Address - Street 1:3612 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9456
Mailing Address - Country:US
Mailing Address - Phone:319-759-4545
Mailing Address - Fax:
Practice Address - Street 1:3612 WEST AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9456
Practice Address - Country:US
Practice Address - Phone:319-759-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty