Provider Demographics
NPI:1821651043
Name:LONG, CARLTON BRANDON (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:BRANDON
Last Name:LONG
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FREDONIA RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3366
Mailing Address - Country:US
Mailing Address - Phone:931-808-7470
Mailing Address - Fax:
Practice Address - Street 1:302 S WOODLAND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1761
Practice Address - Country:US
Practice Address - Phone:931-954-5212
Practice Address - Fax:931-954-5095
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor