Provider Demographics
NPI:1669436416
Name:LANGSTON, STEPHAN MICHEAL (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:MICHEAL
Last Name:LANGSTON
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 1:403 RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2231
Mailing Address - Country:US
Mailing Address - Phone:706-882-1000
Mailing Address - Fax:706-882-1070
Practice Address - Street 1:403 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2231
Practice Address - Country:US
Practice Address - Phone:706-882-1000
Practice Address - Fax:706-882-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7119Medicare ID - Type Unspecified