Provider Demographics
NPI:1437348729
Name:LONGHURST, DONALD LOUIS (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LOUIS
Last Name:LONGHURST
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2321
Mailing Address - Country:US
Mailing Address - Phone:678-525-8583
Mailing Address - Fax:
Practice Address - Street 1:911 N TENNESSEE ST
Practice Address - Street 2:STE 105
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8514
Practice Address - Country:US
Practice Address - Phone:678-995-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008261111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11844411OtherCAQH
GA8251342OtherCIGNA
GA52238714-001OtherBCBS-GA
GA9966131OtherAETNA
GA1102822OtherASHN
GA9966131OtherAETNA