Healthcare Provider Details

I. General information

NPI: 1851713671
Provider Name (Legal Business Name): LANGE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PLEASANT ST STE 2
NORTHAMPTON MA
01060-3917
US

IV. Provider business mailing address

300 PLEASANT ST., SUITE #2
NORTHAMPTON MA
01060
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-9889
  • Fax:
Mailing address:
  • Phone: 413-582-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2720
License Number StateMA

VIII. Authorized Official

Name: KIMBERLY LANGE
Title or Position: OWNE
Credential:
Phone: 413-582-9889