Provider Demographics
NPI:1568689230
Name:FURLONG, MARTIN P (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:P
Last Name:FURLONG
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 1:395 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6029
Mailing Address - Country:US
Mailing Address - Phone:651-771-1703
Mailing Address - Fax:651-771-1638
Practice Address - Street 1:395 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6029
Practice Address - Country:US
Practice Address - Phone:651-771-1703
Practice Address - Fax:651-771-1638
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093746018OtherNPI FOR METROEAST CHIRPRA