Provider Demographics
NPI:1114022100
Name:LONG, KEVIN L (DC, DACRB, FMS, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:LONG
Suffix:
Gender:M
Credentials:DC, DACRB, FMS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4012
Mailing Address - Country:US
Mailing Address - Phone:717-394-6558
Mailing Address - Fax:717-394-6813
Practice Address - Street 1:3141 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4012
Practice Address - Country:US
Practice Address - Phone:717-394-6558
Practice Address - Fax:717-394-6813
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006842-L111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALO445351OtherHIGHMARK PROVIDER NUMBER
PAU63694Medicare UPIN
PA445351 W6BMedicare PIN