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General NPI Number Information
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NPI Number | 1689064578
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Entity Type | Organization
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Legal Business Name | DUANE R DELONG, DC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 9621 MICKELBERRY RD NW SUITE 108
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City | SILVERDALE
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State | WA
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Zip | 98383-8301
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Country | US
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Telephone | 360-692-5350
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Fax | 360-692-5354
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Provider Business Mailing Address
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Address Line | 9621 MICKELBERRY RD NW SUITE 108
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City | SILVERDALE
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State | WA
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Zip | 98383-8301
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Country | US
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Telephone | 360-692-5350
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Fax | 360-692-5354
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUANE ROBERT DELONG
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Credential | CHIROPRACTOR
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Telephone | 360-710-1730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1590
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License Number State | WA
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