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General NPI Number Information
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NPI Number | 1679600894
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Entity Type | Individual
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Provider Name | MARTIN EDWARD LONGNER D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3712 HIGHWAY 95 STE 8
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8175
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Country | US
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Telephone | 928-763-9333
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Fax | 928-763-9313
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Provider Business Mailing Address
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Address Line | 3712 HIGHWAY 95 STE 8
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8175
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Country | US
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Telephone | 928-763-9333
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Fax | 928-763-9313
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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 | 7012
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License Number State | AZ
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