Healthcare Provider Details

I. General information

NPI: 1437348729
Provider Name (Legal Business Name): DONALD LOUIS LONGHURST B.S., D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N TENNESSEE ST STE 105
CARTERSVILLE GA
30120-8514
US

IV. Provider business mailing address

2 SHADOW LN
CARTERSVILLE GA
30120-2321
US

V. Phone/Fax

Practice location:
  • Phone: 678-995-8475
  • Fax:
Mailing address:
  • Phone: 678-525-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008261
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR008261
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: