MEDICARE: DR. WILLIAM V LONGSTRETH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	CH0002540	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH00002540	OTHER	FL	STATE LISCENSE

General Provider Information

NPI Number	:	1265530448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM V LONGSTRETH DC

Provider Business Mailing Address
First Line	:	824 SE 9TH ST
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5632
Country	:	US
Telephone Number	:	954-570-8022
Fax Number	:	954-420-5505

Provider Business Practice Location Address
First Line	:	824 SE 9TH ST
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5632
Country	:	US
Telephone Number	:	954-570-8022
Fax Number	:	954-420-5505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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