Provider Demographics
NPI:1447244850
Name:LONGO, STEVEN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:LONGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 W FOREST HOME AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3407
Mailing Address - Country:US
Mailing Address - Phone:414-421-2225
Mailing Address - Fax:414-421-7576
Practice Address - Street 1:8405 W FOREST HOME AVE
Practice Address - Street 2:STE 101
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3407
Practice Address - Country:US
Practice Address - Phone:414-421-2225
Practice Address - Fax:414-421-7576
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2553012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38849900Medicaid
WI7061Medicare ID - Type Unspecified
WI38849900Medicaid