MEDICARE: DR. JONATHON E LANGENBACHER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2005035665	MO
2	111N00000X	Chiropractor	038010515	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	735170	OTHER	IL	HEALTHLINK
2	08232176	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386764835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHON E LANGENBACHER D.C.

Provider Business Mailing Address
First Line	:	600 S OAK ST
Second Line	:
City	:	UNION
State	:	MO
Zip	:	63084-2112
Country	:	US
Telephone Number	:	314-610-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2476 TAYLOR RD
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63040-1222
Country	:	US
Telephone Number	:	636-458-7575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/24/2008

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Directions to “ DR. JONATHON E LANGENBACHER D.C.” Practice Location

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