Provider Demographics
NPI:1528121530
Name:LANG, PAUL JAY (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:LANG
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 1:18281 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3345
Mailing Address - Country:US
Mailing Address - Phone:612-499-5542
Mailing Address - Fax:
Practice Address - Street 1:18281 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3345
Practice Address - Country:US
Practice Address - Phone:612-499-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP650201OtherOXFORD PROVIDER ID
NJNJ02153OtherLANDMARK PROVIDER ID
NJT77832Medicare UPIN
NJ454695Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID