Provider Demographics
NPI:1689627408
Name:LANGE, TODD R (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:LANGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:R
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3612 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9456
Mailing Address - Country:US
Mailing Address - Phone:319-759-4545
Mailing Address - Fax:
Practice Address - Street 1:520 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1843
Practice Address - Country:US
Practice Address - Phone:319-385-1430
Practice Address - Fax:319-385-1431
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008714111N00000X
IAA06008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3622485OtherBC/BS
3622485OtherBC/BS
U74604Medicare UPIN