Provider Demographics
NPI:1336144336
Name:LONGAN, ROBERT D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:LONGAN
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 1:441 BROADWAY
Mailing Address - Street 2:BOX 696
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0696
Mailing Address - Country:US
Mailing Address - Phone:308-882-5532
Mailing Address - Fax:
Practice Address - Street 1:441 BROADWAY
Practice Address - Street 2:BOX 696
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-0696
Practice Address - Country:US
Practice Address - Phone:308-882-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE21-5705010OtherSTATE EMPLOYER (SIN)
47-0718052OtherFED. EMPLOYER (FIN)
NE470718052-00Medicaid
NE09704OtherBC/BS OF NEBRASKA
NE470718052-00Medicaid
NE21-5705010OtherSTATE EMPLOYER (SIN)