Provider Demographics
NPI:1508942798
Name:LONGENECKER, JOHN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:LONGENECKER
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:P.O. BOX 140034
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-0034
Mailing Address - Country:US
Mailing Address - Phone:972-254-2225
Mailing Address - Fax:972-717-2223
Practice Address - Street 1:4301 N. MACARTHUR BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6497
Practice Address - Country:US
Practice Address - Phone:972-717-2225
Practice Address - Fax:972-717-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U67219Medicare UPIN
TX605623Medicare ID - Type Unspecified