Provider Demographics
NPI:1013996743
Name:BYRNES-LANGE, JILL C (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:BYRNES-LANGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 N PARK PL NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6210
Mailing Address - Country:US
Mailing Address - Phone:319-393-4807
Mailing Address - Fax:319-393-7936
Practice Address - Street 1:5225 N PARK PL NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6210
Practice Address - Country:US
Practice Address - Phone:319-393-4807
Practice Address - Fax:319-393-7936
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223461Medicaid
IA42961OtherWELLMARK BLUE CROSS
IA42961Medicare ID - Type UnspecifiedMEDICARE
IA0223461Medicaid