MEDICARE: DR. KENT CHARLES LONG D.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	111NR0400X	Rehabilitation Chiropractor	1362	OH

General Provider Information

NPI Number	:	1649323379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT CHARLES LONG D.C.

Provider Business Mailing Address
First Line	:	4978 NORTHCUTT PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3840
Country	:	US
Telephone Number	:	937-278-7246
Fax Number	:	937-278-5640

Provider Business Practice Location Address
First Line	:	4978 NORTHCUTT PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3840
Country	:	US
Telephone Number	:	937-278-7246
Fax Number	:	937-278-5640

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	11/18/2009

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Directions to “ DR. KENT CHARLES LONG D.C.” Practice Location

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