Provider Demographics
NPI:1790186609
Name:LONGWOOD FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LONGWOOD FAMILY CHIROPRACTIC, P.C.
Other - Org Name:LONGWOOD FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIIA
Authorized Official - Middle Name:JAAGUS
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-888-3450
Mailing Address - Street 1:400 OLD FORGE LN
Mailing Address - Street 2:SUITE 402
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1914
Mailing Address - Country:US
Mailing Address - Phone:484-888-3450
Mailing Address - Fax:484-770-8779
Practice Address - Street 1:400 OLD FORGE LN STE 402
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1914
Practice Address - Country:US
Practice Address - Phone:484-888-3450
Practice Address - Fax:484-667-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty