Provider Demographics
NPI:1629263603
Name:LONG CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:LONG CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-227-1113
Mailing Address - Street 1:136 KISSANE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1895
Mailing Address - Country:US
Mailing Address - Phone:810-227-1113
Mailing Address - Fax:
Practice Address - Street 1:136 KISSANE AVE STE C
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1895
Practice Address - Country:US
Practice Address - Phone:810-227-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU85777Medicare UPIN
MION32260Medicare PIN