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General NPI Number Information
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NPI Number | 1568916872
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Entity Type | Individual
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Provider Name | CHANDA JEAN LONGWORTH D.C.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 7023 MEARS GATE DR NW STE B
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City | NORTH CANTON
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State | OH
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Zip | 44720-8849
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Country | US
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Telephone | 330-494-5554
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Fax | 330-494-2792
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Provider Business Mailing Address
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Address Line | 7023 MEARS GATE DR NW STE B
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City | NORTH CANTON
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State | OH
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Zip | 44720-8849
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Country | US
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Telephone | 330-494-5554
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Fax | 330-494-2792
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4646
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License Number State | OH
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