Healthcare Provider Details

I. General information

NPI: 1164341624
Provider Name (Legal Business Name): GARY JOHN LONGACRE III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TREY LONGACRE DC

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S MUSTANG RD
YUKON OK
73099-6777
US

IV. Provider business mailing address

710 S MUSTANG RD
YUKON OK
73099-6777
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-4403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4725
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: