Provider Demographics
NPI:1841491511
Name:LONG, REBECCA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 NE 59TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2735
Mailing Address - Country:US
Mailing Address - Phone:206-579-5439
Mailing Address - Fax:
Practice Address - Street 1:5901 ROOSEVELT WAY NE STE 101A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2763
Practice Address - Country:US
Practice Address - Phone:206-525-5664
Practice Address - Fax:206-525-6106
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB20477Medicare ID - Type Unspecified