Provider Demographics
NPI:1417389438
Name:BRENT DELONG, PLLC
Entity Type:Organization
Organization Name:BRENT DELONG, PLLC
Other - Org Name:CORNERSTONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-701-5345
Mailing Address - Street 1:1018 24TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6543
Mailing Address - Country:US
Mailing Address - Phone:405-701-5345
Mailing Address - Fax:405-701-5346
Practice Address - Street 1:1018 24TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6543
Practice Address - Country:US
Practice Address - Phone:405-701-5345
Practice Address - Fax:405-701-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3991111N00000X
OK4126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty