=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194032300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY LYNN INNES-LANG D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 09/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 553 BECKETT RD SUITE 406
-----------------------------------------------------
City | SWEDESBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08085-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-467-3535
-----------------------------------------------------
Fax | 856-467-1911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 553 BECKETT RD SUITE 406
-----------------------------------------------------
City | SWEDESBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08085-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-467-3535
-----------------------------------------------------
Fax | 856-467-1911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00471600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------