Provider Demographics
NPI:1457643496
Name:GARY LORANGER DC PC
Entity Type:Organization
Organization Name:GARY LORANGER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LORANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-675-7090
Mailing Address - Street 1:1811 KING RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1106
Mailing Address - Country:US
Mailing Address - Phone:734-675-7090
Mailing Address - Fax:734-675-2813
Practice Address - Street 1:1811 KING RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1106
Practice Address - Country:US
Practice Address - Phone:734-675-7090
Practice Address - Fax:734-675-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q25040Medicare PIN