Provider Demographics
NPI:1295991917
Name:JOSEPH LONG DC PA
Entity type:Organization
Organization Name:JOSEPH LONG DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-425-5853
Mailing Address - Street 1:506 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2913
Mailing Address - Country:US
Mailing Address - Phone:870-424-5853
Mailing Address - Fax:870-424-5856
Practice Address - Street 1:506 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2913
Practice Address - Country:US
Practice Address - Phone:870-424-5853
Practice Address - Fax:870-424-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137621718Medicaid
AR137621718Medicaid
AR5U389Medicare PIN