Provider Demographics
NPI:1851807887
Name:DANIEL LONG
Entity Type:Organization
Organization Name:DANIEL LONG
Other - Org Name:COFFEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-850-2225
Mailing Address - Street 1:4701 AUBURN WAY N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1312
Mailing Address - Country:US
Mailing Address - Phone:253-850-2225
Mailing Address - Fax:253-850-5757
Practice Address - Street 1:514 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4335
Practice Address - Country:US
Practice Address - Phone:253-850-2225
Practice Address - Fax:253-850-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60708990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty