Provider Demographics
NPI:1891243408
Name:GURULE-LONG, ERIK BRIAN (DC, LMT)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:BRIAN
Last Name:GURULE-LONG
Suffix:
Gender:M
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4383
Mailing Address - Country:US
Mailing Address - Phone:503-999-1390
Mailing Address - Fax:
Practice Address - Street 1:2620 RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5013
Practice Address - Country:US
Practice Address - Phone:503-999-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5801111N00000X
OR17784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist