Provider Demographics
NPI:1891863296
Name:LONG, LYNNETTE NADINE (DC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:NADINE
Last Name:LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4359 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7113
Mailing Address - Country:US
Mailing Address - Phone:916-933-4507
Mailing Address - Fax:916-933-4521
Practice Address - Street 1:4359 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7113
Practice Address - Country:US
Practice Address - Phone:916-933-4507
Practice Address - Fax:916-933-4521
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor