Provider Demographics
NPI:1851713671
Name:LANGE CHIROPRACTIC
Entity Type:Organization
Organization Name:LANGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-582-9889
Mailing Address - Street 1:300 PLEASANT ST., SUITE #2
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-582-9889
Mailing Address - Fax:
Practice Address - Street 1:300 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3917
Practice Address - Country:US
Practice Address - Phone:413-582-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2720111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8576V1OtherBC/BSEMPIRE
MAAA49913OtherHPHC
MA1613910OtherMASSHEALTH
MA446919OtherTUFTS
MA406897OtherGIC
MA3911018OtherCIGNA
MAY37056OtherBC/BS
MAAA49913OtherHPHC