Provider Demographics
NPI:1396878591
Name:LONGIE CHIROPRACTIC
Entity type:Organization
Organization Name:LONGIE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:LONGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-631-3460
Mailing Address - Street 1:214 WARD CIR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7563
Mailing Address - Country:US
Mailing Address - Phone:615-631-3460
Mailing Address - Fax:
Practice Address - Street 1:214 WARD CIR
Practice Address - Street 2:SUITE 800
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7563
Practice Address - Country:US
Practice Address - Phone:615-631-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0108243OtherBCBS PROVIDER NUMBER
TN0108243OtherBCBS PROVIDER NUMBER
TN=========OtherFEDERAL
TNT-73725Medicare UPIN
TN0108243OtherBCBS PROVIDER NUMBER