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General NPI Number Information
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NPI Number | 1902176373
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Entity Type | Organization
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Legal Business Name | LONG CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 810 E SUNFLOWER RD SUITE 100 E
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City | CLEVELAND
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State | MS
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Zip | 38732-2800
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Country | US
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Telephone | 662-721-4496
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Fax | 662-721-4497
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | CLEVELAND
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State | MS
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Zip | 38732-0069
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Country | US
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Telephone | 662-721-4496
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Fax | 662-721-4497
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JOY VICTORIA LONG
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Credential | DC
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Telephone | 662-721-4496
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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 | 1184
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License Number State | MS
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