Provider Demographics
NPI:1518050632
Name:HEALTHFIRST 002 LLC
Entity Type:Organization
Organization Name:HEALTHFIRST 002 LLC
Other - Org Name:LONGO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-905-1720
Mailing Address - Street 1:2269 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3179
Mailing Address - Country:US
Mailing Address - Phone:931-905-1720
Mailing Address - Fax:
Practice Address - Street 1:2269 WILMA RUDOLPH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8416
Practice Address - Country:US
Practice Address - Phone:931-905-1720
Practice Address - Fax:931-905-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735765Medicare PIN