Provider Demographics
NPI:1497977250
Name:DR. MARY E. LONG, D.C., P.A.
Entity Type:Organization
Organization Name:DR. MARY E. LONG, D.C., P.A.
Other - Org Name:ABSOLUTE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-496-9099
Mailing Address - Street 1:3112 N JUPITER RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6578
Mailing Address - Country:US
Mailing Address - Phone:972-496-9099
Mailing Address - Fax:972-496-8910
Practice Address - Street 1:3112 N JUPITER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6578
Practice Address - Country:US
Practice Address - Phone:972-496-9099
Practice Address - Fax:972-496-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty