Healthcare Provider Details

I. General information

NPI: 1063884732
Provider Name (Legal Business Name): JOSHUA LONGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EAST AVE
LINCOLN CA
95648
US

IV. Provider business mailing address

421 A ST STE 600
LINCOLN CA
95648-1974
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: