Provider Demographics
NPI:1972705499
Name:GALLES-LONG, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GALLES-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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-0147
Mailing Address - Country:US
Mailing Address - Phone:580-657-6664
Mailing Address - Fax:580-657-6663
Practice Address - Street 1:1702 N COMMERCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1525
Practice Address - Country:US
Practice Address - Phone:580-223-8200
Practice Address - Fax:580-223-8212
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU77466Medicare UPIN