Provider Demographics
NPI:1104348085
Name:LANGENDORF, LINDSEY NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:NICOLE
Last Name:LANGENDORF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:NICOLE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:62 EXECUTIVE PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5822
Mailing Address - Country:US
Mailing Address - Phone:618-650-8062
Mailing Address - Fax:
Practice Address - Street 1:62 EXECUTIVE PLAZA CT
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-650-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor