Provider Demographics
NPI:1912186560
Name:LANGWEILER, MARK JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:LANGWEILER
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 1:602 N DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1514
Mailing Address - Country:US
Mailing Address - Phone:609-576-9388
Mailing Address - Fax:
Practice Address - Street 1:4 E JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4465
Practice Address - Country:US
Practice Address - Phone:609-576-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor