Healthcare Provider Details

I. General information

NPI: 1801002191
Provider Name (Legal Business Name): LONGAN CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 BROADWAY BOX 696
IMPERIAL NE
69033-3162
US

IV. Provider business mailing address

441 BROADWAY BOX 696
IMPERIAL NE
69033-3162
US

V. Phone/Fax

Practice location:
  • Phone: 308-882-5532
  • Fax:
Mailing address:
  • Phone: 308-882-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number945
License Number StateNE

VIII. Authorized Official

Name: DR. ROBERT D. LONGAN
Title or Position: OWNER
Credential: D.C.
Phone: 308-882-5532