Provider Demographics
NPI:1346415122
Name:G V LONG D. C.
Entity Type:Organization
Organization Name:G V LONG D. C.
Other - Org Name:CHAPIN CHIROPRACTIC HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:803-345-3466
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-0190
Mailing Address - Country:US
Mailing Address - Phone:803-345-3466
Mailing Address - Fax:803-345-3466
Practice Address - Street 1:1402 CHAPIN RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-345-3466
Practice Address - Fax:803-345-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty