Provider Demographics
NPI:1528096740
Name:LORANGER, BRIAN KENNETH (DC, DACS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:LORANGER
Suffix:
Gender:M
Credentials:DC, DACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2719
Mailing Address - Country:US
Mailing Address - Phone:734-697-4244
Mailing Address - Fax:734-697-8102
Practice Address - Street 1:125 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2719
Practice Address - Country:US
Practice Address - Phone:734-697-4244
Practice Address - Fax:734-697-8102
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBL005254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H25174OtherBCBS
MIP00380234OtherMEDICARE RAILROAD
MI1783418Medicaid
MIP51960001Medicare UPIN
MI0H251746951Medicare PIN