Provider Demographics
NPI:1598004996
Name:LANGE, JESSIE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:KAY
Last Name:LANGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSIE
Other - Middle Name:KAY
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3377 N CROSS BRIDGES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7124
Mailing Address - Country:US
Mailing Address - Phone:931-698-6166
Mailing Address - Fax:
Practice Address - Street 1:3377 N CROSS BRIDGES RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7124
Practice Address - Country:US
Practice Address - Phone:931-698-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013003596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor