Provider Demographics
NPI:1922375229
Name:RIVER HEALTH PC
Entity Type:Organization
Organization Name:RIVER HEALTH PC
Other - Org Name:LONGNER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-763-9333
Mailing Address - Street 1:3712 HIGHWAY 95 STE 8
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-763-9333
Mailing Address - Fax:928-763-9313
Practice Address - Street 1:3712 HIGHWAY 95 STE 8
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8175
Practice Address - Country:US
Practice Address - Phone:928-763-9333
Practice Address - Fax:928-763-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU83530Medicare UPIN
AZ64144Medicare PIN