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General NPI Number Information
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NPI Number | 1902153976
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Entity Type | Organization
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Legal Business Name | LONGACRE CHIROPRACTIC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 210 S ELM ST #101
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City | DENTON
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State | TX
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Zip | 76201-6050
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Country | US
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Telephone | 469-549-1810
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Fax | 469-533-0383
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Provider Business Mailing Address
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Address Line | 210 S ELM ST #101
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City | DENTON
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State | TX
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Zip | 76201-6050
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Country | US
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Telephone | 469-549-1810
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Fax | 469-533-0383
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MICHEL LONGACRE
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Credential | D.C.
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Telephone | 469-549-1810
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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 | 8967
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License Number State | TX
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