Provider Demographics
NPI:1649326851
Name:LANGE, CHANDROUTIE PAM (LAC)
Entity type:Individual
Prefix:
First Name:CHANDROUTIE
Middle Name:PAM
Last Name:LANGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77-114 NAHALE PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2418
Mailing Address - Country:US
Mailing Address - Phone:808-322-5662
Mailing Address - Fax:808-322-9617
Practice Address - Street 1:77-114 NAHALE PL
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2418
Practice Address - Country:US
Practice Address - Phone:808-322-5662
Practice Address - Fax:808-322-9617
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI238OtherSTATE LICENSE NUMBER