Provider Demographics
NPI:1689064578
Name:DUANE R DELONG, DC
Entity Type:Organization
Organization Name:DUANE R DELONG, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:360-710-1730
Mailing Address - Street 1:9621 MICKELBERRY RD NW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8301
Mailing Address - Country:US
Mailing Address - Phone:360-692-5350
Mailing Address - Fax:360-692-5354
Practice Address - Street 1:9621 MICKELBERRY RD NW
Practice Address - Street 2:SUITE 108
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8301
Practice Address - Country:US
Practice Address - Phone:360-692-5350
Practice Address - Fax:360-692-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1590261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316959778Medicare PIN