Provider Demographics
NPI:1639461056
Name:LANGAN, TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:LANGAN
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 1:3121 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7925
Mailing Address - Country:US
Mailing Address - Phone:530-541-5660
Mailing Address - Fax:866-899-6251
Practice Address - Street 1:3121 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7925
Practice Address - Country:US
Practice Address - Phone:530-541-5660
Practice Address - Fax:866-899-6251
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33450111N00000X
TX11029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor