Provider Demographics
NPI:1568916872
Name:LONGWORTH, CHANDA JEAN (DC)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:JEAN
Last Name:LONGWORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 MEARS GATE DR NW
Mailing Address - Street 2:STE B
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8849
Mailing Address - Country:US
Mailing Address - Phone:330-494-5554
Mailing Address - Fax:330-494-2792
Practice Address - Street 1:7023 MEARS GATE DR NW STE B
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8849
Practice Address - Country:US
Practice Address - Phone:330-494-5554
Practice Address - Fax:330-494-2792
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor