Healthcare Provider Details

I. General information

NPI: 1811135148
Provider Name (Legal Business Name): LONG ACUPUNCTURE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 JOLLY RD SUITE 120
OKEMOS MI
48864-3676
US

IV. Provider business mailing address

2501 JOLLY RD SUITE 120
OKEMOS MI
48864-3676
US

V. Phone/Fax

Practice location:
  • Phone: 517-381-0299
  • Fax: 517-381-9950
Mailing address:
  • Phone: 517-381-0299
  • Fax: 517-381-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberNCCAOM #015392
License Number State

VIII. Authorized Official

Name: MEGAN L LONG
Title or Position: BOARD CERTIFIED ACUPUNCTURIST
Credential: DIPL. AC
Phone: 517-381-0299