Provider Demographics
NPI:1639340342
Name:LONGMAN, STEPHEN R (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:LONGMAN
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 1:3551 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2109
Mailing Address - Country:US
Mailing Address - Phone:612-767-9900
Mailing Address - Fax:612-767-1100
Practice Address - Street 1:3551 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2109
Practice Address - Country:US
Practice Address - Phone:612-767-9900
Practice Address - Fax:612-767-1100
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2401111N00000X
CO5028111N00000X
MN3171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU66588Medicare UPIN