Provider Demographics
NPI:1417506171
Name:LONGWORTH CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:LONGWORTH CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:LONGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-494-5554
Mailing Address - Street 1:7023 MEARS GATE DR
Mailing Address - Street 2:STE B
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8849
Mailing Address - Country:US
Mailing Address - Phone:330-494-5554
Mailing Address - Fax:330-494-2792
Practice Address - Street 1:7023 MEARS GATE DR
Practice Address - Street 2:STE B
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8849
Practice Address - Country:US
Practice Address - Phone:330-494-5554
Practice Address - Fax:330-494-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty