Healthcare Provider Details

I. General information

NPI: 1619804200
Provider Name (Legal Business Name): ANDREW LONGNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 HIGHWAY 95 STE 8
BULLHEAD CITY AZ
86442-8175
US

IV. Provider business mailing address

3712 HIGHWAY 95 STE 8
BULLHEAD CITY AZ
86442-8175
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-9333
  • Fax: 928-763-9313
Mailing address:
  • Phone: 928-763-9333
  • Fax: 928-763-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: