Healthcare Provider Details

I. General information

NPI: 1164002028
Provider Name (Legal Business Name): ERIN M LONG DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE
ALBUQUERQUE NM
87111-2087
US

IV. Provider business mailing address

8400 OSUNA RD NE
ALBUQUERQUE NM
87111-2087
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-4796
  • Fax:
Mailing address:
  • Phone: 505-259-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC2266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: