Provider Demographics
NPI:1346540713
Name:DELONG, BRENTON D (D,C,)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:D
Last Name:DELONG
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMONI
Mailing Address - State:IA
Mailing Address - Zip Code:50140-1209
Mailing Address - Country:US
Mailing Address - Phone:563-271-4095
Mailing Address - Fax:
Practice Address - Street 1:1018 24TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6543
Practice Address - Country:US
Practice Address - Phone:563-271-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor