Provider Demographics
NPI:1609836832
Name:LANGLEY, GERALD ANDREW (DC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ANDREW
Last Name:LANGLEY
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 1:2905 N OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2255
Mailing Address - Country:US
Mailing Address - Phone:765-254-1270
Mailing Address - Fax:765-254-1271
Practice Address - Street 1:2905 N OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2255
Practice Address - Country:US
Practice Address - Phone:765-254-1270
Practice Address - Fax:765-254-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001391A111N00000X
IN81000031A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107390AMedicaid
IN208700Medicare ID - Type Unspecified
IN100107390AMedicaid