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General NPI Number Information
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NPI Number | 1033107545
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Entity Type | Individual
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Provider Name | JACKY RAY LANGSTON DC
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 E 5TH ST
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City | TUSCUMBIA
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State | AL
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Zip | 35674-2409
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Country | US
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Telephone | 256-383-6238
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Fax | 256-383-6234
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Provider Business Mailing Address
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Address Line | PO BOX 256
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City | TUSCUMBIA
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State | AL
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Zip | 35674-0256
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Country | US
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Telephone | 256-383-6238
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Fax | 256-383-6234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 744
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License Number State | AL
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