MEDICARE: LONGO CHIROPRACTIC, S.C.

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	111N00000X	Chiropractor	2553-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467663450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGO CHIROPRACTIC, S.C.

Provider Business Mailing Address
First Line	:	8405 W FOREST HOME AVE
Second Line	:	SUITE 101
City	:	GREENFIELD
State	:	WI
Zip	:	53228-3407
Country	:	US
Telephone Number	:	414-421-2225
Fax Number	:	414-421-7516

Provider Business Practice Location Address
First Line	:	8405 W FOREST HOME AVE
Second Line	:	SUITE 101
City	:	GREENFIELD
State	:	WI
Zip	:	53228-3407
Country	:	US
Telephone Number	:	414-421-2225
Fax Number	:	414-421-7516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN MICHAEL LONGO
Credential	:	D.C.
Telephone Number	:	414-421-2225

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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Directions to “LONGO CHIROPRACTIC, S.C. ” Practice Location

Language	Start Address	Practice Location

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