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General NPI Number Information
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NPI Number | 1497977250
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Entity Type | Organization
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Legal Business Name | DR. MARY E. LONG, D.C., P.A.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3112 N JUPITER RD SUITE 310
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City | GARLAND
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State | TX
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Zip | 75044-6578
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Country | US
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Telephone | 972-496-9099
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Fax | 972-496-8910
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Provider Business Mailing Address
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Address Line | 3112 N JUPITER RD SUITE 310
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City | GARLAND
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State | TX
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Zip | 75044-6578
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Country | US
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Telephone | 972-496-9099
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Fax | 972-496-8910
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY ELIZABETH LONG
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Credential | D.C.
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Telephone | 972-496-9099
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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 | 10358
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License Number State | TX
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