Provider Demographics
NPI:1811135148
Name:LONG ACUPUNCTURE, INCORPORATED
Entity type:Organization
Organization Name:LONG ACUPUNCTURE, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL AC
Authorized Official - Phone:517-381-0299
Mailing Address - Street 1:2501 JOLLY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3676
Mailing Address - Country:US
Mailing Address - Phone:517-381-0299
Mailing Address - Fax:517-381-9950
Practice Address - Street 1:2501 JOLLY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3676
Practice Address - Country:US
Practice Address - Phone:517-381-0299
Practice Address - Fax:517-381-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCAOM #015392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty