Provider Demographics
NPI:1790123461
Name:LONGACRE, CAROLYN DESIMONE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:DESIMONE
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:DESIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:503 W BUTLER RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4833
Mailing Address - Country:US
Mailing Address - Phone:864-297-6270
Mailing Address - Fax:864-509-9378
Practice Address - Street 1:503 W BUTLER RD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4833
Practice Address - Country:US
Practice Address - Phone:864-297-6270
Practice Address - Fax:864-509-9378
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3779111N00000X, 111N00000X
TN2682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor