Provider Demographics
NPI:1790059418
Name:LONG FAMILY CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:LONG FAMILY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-425-3555
Mailing Address - Street 1:604 N THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4634
Mailing Address - Country:US
Mailing Address - Phone:407-425-3555
Mailing Address - Fax:
Practice Address - Street 1:604 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4634
Practice Address - Country:US
Practice Address - Phone:407-425-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8154261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001930000Medicaid
FLE6127Medicare PIN