Provider Demographics
NPI:1568244754
Name:LONG LIFE ALIGNED SPINE CENTER, PLLC
Entity Type:Organization
Organization Name:LONG LIFE ALIGNED SPINE CENTER, PLLC
Other - Org Name:EMBRACE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-382-0084
Mailing Address - Street 1:1006 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3522
Mailing Address - Country:US
Mailing Address - Phone:772-466-5600
Mailing Address - Fax:
Practice Address - Street 1:1006 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-3522
Practice Address - Country:US
Practice Address - Phone:772-466-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty