Provider Demographics
NPI:1629085931
Name:LONG, JOSEPH G (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:LONG
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:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0327
Mailing Address - Country:US
Mailing Address - Phone:870-424-5853
Mailing Address - Fax:870-424-5856
Practice Address - Street 1:506 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2913
Practice Address - Country:US
Practice Address - Phone:870-424-5853
Practice Address - Fax:870-424-5856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1295991917OtherGROUP NPI
AR137621718Medicaid
AR5U389Medicare PIN
ARU76621Medicare UPIN