Individual
JEFFREY LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
810 MARKET ST, METROPOLIS, IL 62960-1636
(618) 524-7575
Mailing address
810 MARKET ST, METROPOLIS, IL 62960-1636
(618) 524-7575
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007962
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038007962
—
IL
01
—
06422045
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/04/2006
Last updated
07/08/2007
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