Provider Demographics
NPI:1689053209
Name:LANGE, BRETT (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:LANGE
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 1:13757 W BELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2452
Mailing Address - Country:US
Mailing Address - Phone:623-214-7600
Mailing Address - Fax:623-214-7662
Practice Address - Street 1:13757 W BELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2452
Practice Address - Country:US
Practice Address - Phone:623-214-7600
Practice Address - Fax:623-214-7662
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor