Provider Demographics
NPI:1467663450
Name:LONGO CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:LONGO CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-421-2225
Mailing Address - Street 1:8405 W FOREST HOME AVE
Mailing Address - Street 2:SUITE 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:414-421-7516
Practice Address - Street 1:8405 W FOREST HOME AVE
Practice Address - Street 2:SUITE 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:414-421-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2553-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38849900Medicaid
WI38849900Medicaid
WIT98250Medicare UPIN