Provider Demographics
NPI:1497831077
Name:LONGMAN, KRISTEN LESLIE (DC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LESLIE
Last Name:LONGMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LESLIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8207 MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8889
Mailing Address - Country:US
Mailing Address - Phone:910-686-6508
Mailing Address - Fax:910-686-8416
Practice Address - Street 1:8207 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8889
Practice Address - Country:US
Practice Address - Phone:910-686-6508
Practice Address - Fax:910-686-8416
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC662946OtherACN
NC085H0OtherBLUE CROSS BLUE SHIELD
NC085H0OtherBLUE CROSS BLUE SHIELD
NCU80545Medicare UPIN