Provider Demographics
NPI:1821206756
Name:THE LONGEVITY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:THE LONGEVITY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-900-2671
Mailing Address - Street 1:PO BOX 3782
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-6782
Mailing Address - Country:US
Mailing Address - Phone:972-900-2671
Mailing Address - Fax:
Practice Address - Street 1:3762 HWY 434
Practice Address - Street 2:
Practice Address - City:ANGEL FIRE
Practice Address - State:NM
Practice Address - Zip Code:87710
Practice Address - Country:US
Practice Address - Phone:505-920-6785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty