Provider Demographics
NPI:1972538320
Name:LONGACRE, MICHEL F (DC)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:F
Last Name:LONGACRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3097
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:1001 CROSS TIMBERS RD
Practice Address - Street 2:STE 2070
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1371
Practice Address - Country:US
Practice Address - Phone:469-549-1810
Practice Address - Fax:469-549-1820
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166344501Medicaid
TX166344502Medicaid
TX8C0085Medicare ID - Type Unspecified
TX166344501Medicaid
TX8C0086Medicare ID - Type Unspecified