Healthcare Provider Details

I. General information

NPI: 1053782151
Provider Name (Legal Business Name): JOSHUA LONGO D.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EAST AVE
LINCOLN CA
95648-2007
US

IV. Provider business mailing address

1105 EAST AVE
LINCOLN CA
95648-2007
US

V. Phone/Fax

Practice location:
  • Phone: 916-645-3890
  • Fax:
Mailing address:
  • Phone: 916-645-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26433
License Number StateCA

VIII. Authorized Official

Name: DR. JOSHUA GRIFFEN LONGO
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 415-385-0730