Individual
JAY K LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
413 S 6TH ST, BRAINERD, MN 56401
(218) 828-4418
(218) 828-4575
Mailing address
413 S 6TH ST, BRAINERD, MN 56401
(218) 828-4418
(218) 828-4575
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350041435
MEDICARE RR
—
01
—
6C186LA
BCBS
—
05
—
778527500
—
MN
Enumeration date
08/18/2006
Last updated
06/21/2011
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