Provider Demographics
NPI:1184994634
Name:LONG, JOY VICTORIA (DC)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:VICTORIA
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-0069
Mailing Address - Country:US
Mailing Address - Phone:662-721-4496
Mailing Address - Fax:662-721-4497
Practice Address - Street 1:810 E SUNFLOWER RD
Practice Address - Street 2:SUITE 100E
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2800
Practice Address - Country:US
Practice Address - Phone:662-721-4496
Practice Address - Fax:662-721-4497
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor