Provider Demographics
NPI:1740770981
Name:LONGO, MICHAEL JA (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JA
Last Name:LONGO
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 1:614 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1100
Mailing Address - Country:US
Mailing Address - Phone:253-380-4752
Mailing Address - Fax:
Practice Address - Street 1:614 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1100
Practice Address - Country:US
Practice Address - Phone:253-380-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60838165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor