Provider Demographics
NPI:1760521553
Name:LONG, RICK ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:ALLEN
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 1:7665 N ALBINA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1375
Mailing Address - Country:US
Mailing Address - Phone:503-380-9780
Mailing Address - Fax:971-244-8208
Practice Address - Street 1:2225 N LOMBARD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5771
Practice Address - Country:US
Practice Address - Phone:503-380-9780
Practice Address - Fax:971-244-8208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273134111N00000X
WACH00003610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor