Provider Demographics
NPI:1861493645
Name:LANGE, LESLIE WING (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WING
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:GREATER ROCHESTER CHIROPRACTIC
Mailing Address - Street 2:30 ALLENS CREEK RD.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-442-3220
Mailing Address - Fax:585-442-1017
Practice Address - Street 1:GREATER ROCHESTER CHIROPRACTIC
Practice Address - Street 2:30 ALLENS CREEK RD.
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-442-3220
Practice Address - Fax:585-442-1017
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU40973Medicare UPIN