Provider Demographics
NPI:1093119455
Name:LONG, CASSANDRA R (DC)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:R
Last Name:LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1887
Mailing Address - Country:US
Mailing Address - Phone:360-693-3030
Mailing Address - Fax:360-828-1305
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1887
Practice Address - Country:US
Practice Address - Phone:360-693-3030
Practice Address - Fax:360-828-1305
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60507486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor