Provider Demographics
NPI:1609992494
Name:LANGHAM CHIROPRACTIC ENTERPRISES, PA
Entity Type:Organization
Organization Name:LANGHAM CHIROPRACTIC ENTERPRISES, PA
Other - Org Name:NORTHSTAR CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-281-5556
Mailing Address - Street 1:7630 N BEACH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1299
Mailing Address - Country:US
Mailing Address - Phone:817-281-5556
Mailing Address - Fax:817-281-5520
Practice Address - Street 1:7630 N BEACH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1299
Practice Address - Country:US
Practice Address - Phone:817-281-5556
Practice Address - Fax:817-281-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150295702Medicaid
TX0025KZOtherBCBS GROUP NUMBER
TX177429101Medicaid
TX177429101Medicaid