Provider Demographics
NPI:1821311101
Name:LANG, JESSE MICHAEL (DC,)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:MICHAEL
Last Name:LANG
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 1:900 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9403
Mailing Address - Country:US
Mailing Address - Phone:815-436-1988
Mailing Address - Fax:815-436-2278
Practice Address - Street 1:900 GENEVA ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9403
Practice Address - Country:US
Practice Address - Phone:815-436-1988
Practice Address - Fax:815-436-2278
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor