Provider Demographics
NPI:1497880892
Name:LONGIE, RICK BURDETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:BURDETTE
Last Name:LONGIE
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 1:214 WARD CIR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7563
Mailing Address - Country:US
Mailing Address - Phone:615-730-6021
Mailing Address - Fax:615-942-7454
Practice Address - Street 1:214 WARD CIR
Practice Address - Street 2:SUITE 800
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7563
Practice Address - Country:US
Practice Address - Phone:615-730-6021
Practice Address - Fax:615-942-7454
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN431171043OtherTAX ID
TNT-73725Medicare UPIN