Provider Demographics
NPI:1114051174
Name:TOMCHAK LONG, CYNTHIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:TOMCHAK LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:TOMCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2051 W WARNER RD
Mailing Address - Street 2:#1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2100
Mailing Address - Country:US
Mailing Address - Phone:480-963-0504
Mailing Address - Fax:480-963-2899
Practice Address - Street 1:2051 W WARNER RD
Practice Address - Street 2:#1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2100
Practice Address - Country:US
Practice Address - Phone:480-963-0504
Practice Address - Fax:480-963-2899
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ64486Medicare PIN