Provider Demographics
NPI:1164499547
Name:LONG, DOUGLAS L (DC DACNB)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:LONG
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 HARDING PIKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2118
Mailing Address - Country:US
Mailing Address - Phone:615-269-5558
Mailing Address - Fax:615-269-5973
Practice Address - Street 1:4515 HARDING PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2118
Practice Address - Country:US
Practice Address - Phone:615-269-5558
Practice Address - Fax:615-269-5973
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002223111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1670129OtherMEDICARE
TN1670129OtherMEDICARE