Provider Demographics
NPI:1386764835
Name:LANGENBACHER, JONATHON E (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:E
Last Name:LANGENBACHER
Suffix:
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 1:600 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2112
Mailing Address - Country:US
Mailing Address - Phone:314-610-3366
Mailing Address - Fax:
Practice Address - Street 1:2476 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1222
Practice Address - Country:US
Practice Address - Phone:636-458-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005035665111N00000X
IL038010515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL735170OtherHEALTHLINK
IL08232176OtherBLUE CROSS BLUE SHIELD
ILK27488Medicare ID - Type Unspecified