MEDICARE: CHANDA JEAN LONGWORTH D.C.

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	4646	OH

General Provider Information

NPI Number	:	1568916872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDA JEAN LONGWORTH D.C.

Provider Business Mailing Address
First Line	:	7023 MEARS GATE DR NW
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 NW STE B
Second Line	:
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	07/26/2017

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