Provider Demographics
NPI:1861603375
Name:LANGE, MAX KARL (DC)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:KARL
Last Name:LANGE
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 1:11010 BOTTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-8891
Mailing Address - Country:US
Mailing Address - Phone:707-279-1641
Mailing Address - Fax:
Practice Address - Street 1:11010 BOTTLE ROCK RD
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-8891
Practice Address - Country:US
Practice Address - Phone:707-279-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU39831Medicare UPIN
CADC0220450Medicare ID - Type Unspecified