Individual
MR. CORY BRUCE LANGBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5362 W PRAIRIE AVE, POST FALLS, ID 83854-5912
(208) 786-2470
Mailing address
PO BOX 3212, POST FALLS, ID 83877-3212
(208) 786-2470
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
RCT47478
ID
171WH0202X
Home Modifications Contractor
RCT47478
ID
172A00000X
Driver
—
—
251B00000X
Case Management Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
06/04/2019
Last updated
06/26/2019
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