Provider Demographics
NPI:1861591737
Name:LANG CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:LANG CHIROPRACTIC CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-828-4418
Mailing Address - Street 1:413 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3539
Mailing Address - Country:US
Mailing Address - Phone:218-828-4418
Mailing Address - Fax:218-828-4575
Practice Address - Street 1:413 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3539
Practice Address - Country:US
Practice Address - Phone:218-828-4418
Practice Address - Fax:218-828-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140160200Medicaid
MNC02423Medicare ID - Type Unspecified
MNCJ4239Medicare ID - Type UnspecifiedRAILROAD MEDICARE