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General NPI Number Information
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NPI Number | 1316284441
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Entity Type | Organization
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Legal Business Name | LONG CHIROPRACTIC & REHAB CENTER
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 4282 W LINEBAUGH AVE
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City | TAMPA
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State | FL
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Zip | 33624-5241
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Country | US
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Telephone | 813-930-6112
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Fax |
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Provider Business Mailing Address
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Address Line | 4282 W LINEBAUGH AVE
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City | TAMPA
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State | FL
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Zip | 33624-5241
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Country | US
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Telephone | 813-930-6112
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Fax |
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Authorized Official
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Title or Position | ADMIN OFFICER
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Name | MRS. GRACE SUMMA
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Credential | AO
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Telephone | 813-930-6112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH6821
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License Number State | FL
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