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General NPI Number Information
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NPI Number | 1174812473
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Entity Type | Individual
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Provider Name | CASEY JEANNE LONG D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 601 S 32ND AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3958
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Country | US
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Telephone | 715-848-1741
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Fax | 715-848-2225
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Provider Business Mailing Address
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Address Line | 500 W COLLEGE AVE
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City | WITTENBERG
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State | WI
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Zip | 54499-9196
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Country | US
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Telephone | 715-253-2239
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Fax | 715-253-3331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 5509
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4772-012
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License Number State | WI
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