Provider Demographics
NPI:1376625491
Name:LONG CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LONG CHIROPRACTIC, INC.
Other - Org Name:TOWN CENTER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-933-4507
Mailing Address - Street 1:4359 TOWN CENTER BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7113
Mailing Address - Country:US
Mailing Address - Phone:916-933-4507
Mailing Address - Fax:916-933-4521
Practice Address - Street 1:4359 TOWN CENTER BLVD STE 213
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7113
Practice Address - Country:US
Practice Address - Phone:916-933-4507
Practice Address - Fax:916-933-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0229180Medicare ID - Type Unspecified