MEDICARE: LONGWORTH CHIROPRACTIC CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1417506171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGWORTH CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	7023 MEARS GATE DR
Second Line	:	STE B
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8849
Country	:	US
Telephone Number	:	330-494-5554
Fax Number	:	330-494-2792

Provider Business Practice Location Address
First Line	:	7023 MEARS GATE DR
Second Line	:	STE B
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8849
Country	:	US
Telephone Number	:	330-494-5554
Fax Number	:	330-494-2792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CRAIG W LONGWORTH
Credential	:	DC
Telephone Number	:	330-494-5554

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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