Provider Demographics
NPI:1528481439
Name:STANZIE LANGTREE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:STANZIE LANGTREE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANZIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:832-768-9910
Mailing Address - Street 1:16677 NE RUSSELL ST APT 135
Mailing Address - Street 2:#135
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 NE 19TH AVE
Practice Address - Street 2:STE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2829
Practice Address - Country:US
Practice Address - Phone:503-610-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5531261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service