Individual
MR. JORDAN D LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4020 CLEARWATER RD APT 206, SAINT CLOUD, MN 56301-8601
(218) 396-0160
Mailing address
4020 CLEARWATER RD APT 206, SAINT CLOUD, MN 56301-8601
(218) 396-0160
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MN
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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