Healthcare Provider Details

I. General information

NPI: 1164499547
Provider Name (Legal Business Name): DOUGLAS L LONG DC DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 HARDING PIKE SUITE 110
NASHVILLE TN
37205-2118
US

IV. Provider business mailing address

4515 HARDING PIKE SUITE 110
NASHVILLE TN
37205-2118
US

V. Phone/Fax

Practice location:
  • Phone: 615-269-5558
  • Fax: 615-269-5973
Mailing address:
  • Phone: 615-269-5558
  • Fax: 615-269-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC0000002223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: