Provider Demographics
NPI:1194797548
Name:LANGE, NEAL WARREN JR (DC)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:WARREN
Last Name:LANGE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 POSTAL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3537
Mailing Address - Country:US
Mailing Address - Phone:843-236-6291
Mailing Address - Fax:843-872-9190
Practice Address - Street 1:4022 POSTAL WAY
Practice Address - Street 2:SUTE A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3537
Practice Address - Country:US
Practice Address - Phone:843-236-6291
Practice Address - Fax:843-872-9190
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2874Medicaid
SC2164911OtherFIRST HEALTH
SC200524510OtherBCBS
SC200524510OtherAETNA
SC200524510OtherUNITED HEALTHCARE
SC200524510OtherCIGNA
SCGCH435Medicaid
SC200524510OtherSTATE HEALTH PLAN
SC2164911OtherFIRST HEALTH
SCGCH435Medicaid
SC7911Medicare PIN
SCCH2874Medicaid