Provider Demographics
NPI:1912179912
Name:LONG NECK CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LONG NECK CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BALDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-945-4575
Mailing Address - Street 1:98 RUDDER RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-6665
Mailing Address - Country:US
Mailing Address - Phone:302-945-4575
Mailing Address - Fax:302-945-1910
Practice Address - Street 1:98 RUDDER RD
Practice Address - Street 2:UNIT 1
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-6665
Practice Address - Country:US
Practice Address - Phone:302-945-4575
Practice Address - Fax:302-945-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-000249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEBA-557470Medicare PIN