Provider Demographics
NPI:1750196101
Name:LONG, MITCHELL DAVID (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DAVID
Last Name:LONG
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 1:1334 BECCA TEAL PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2242
Mailing Address - Country:US
Mailing Address - Phone:512-217-5194
Mailing Address - Fax:
Practice Address - Street 1:1315 SAM BASS CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2932
Practice Address - Country:US
Practice Address - Phone:512-284-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16369111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation