Healthcare Provider Details

I. General information

NPI: 1689627408
Provider Name (Legal Business Name): TODD R LANGE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TODD R LANGE D.C.

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S GRAND AVE
MOUNT PLEASANT IA
52641-1843
US

IV. Provider business mailing address

3612 WEST AVE
BURLINGTON IA
52601-9456
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-1430
  • Fax: 319-385-1431
Mailing address:
  • Phone: 319-759-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008714
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA06008
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: