Provider Demographics
NPI:1265530448
Name:LONGSTRETH, WILLIAM V (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:LONGSTRETH
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 1:824 SE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5632
Mailing Address - Country:US
Mailing Address - Phone:954-570-8022
Mailing Address - Fax:954-420-5505
Practice Address - Street 1:824 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5632
Practice Address - Country:US
Practice Address - Phone:954-570-8022
Practice Address - Fax:954-420-5505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002540111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH00002540OtherSTATE LISCENSE
FLCH00002540OtherSTATE LISCENSE
FL89935Medicare ID - Type Unspecified