Provider Demographics
NPI:1992967889
Name:LARANGER, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LARANGER
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12485-0910
Mailing Address - Country:US
Mailing Address - Phone:518-589-5683
Mailing Address - Fax:518-589-6327
Practice Address - Street 1:6022 MAIN ST
Practice Address - Street 2:SUITE # 8
Practice Address - City:TANNERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12485-0910
Practice Address - Country:US
Practice Address - Phone:518-589-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6U041OtherMEDICARE PROVIDER#
NYU98408Medicare UPIN