Healthcare Provider Details

I. General information

NPI: 1881105229
Provider Name (Legal Business Name): LANGE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 01/04/2018
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 STE 2
NORTHAMPTON MA
01060-3917
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-9889
  • Fax:
Mailing address:
  • Phone: 413-582-9889
  • Fax: 413-582-9886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateMA

VIII. Authorized Official

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