MEDICARE: MITCHELL DAVID LONG 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	111NR0400X	Rehabilitation Chiropractor	16369	TX

General Provider Information

NPI Number	:	1750196101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL DAVID LONG DC

Provider Business Mailing Address
First Line	:	1334 BECCA TEAL PL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2242
Country	:	US
Telephone Number	:	512-217-5194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 SAM BASS CIR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2932
Country	:	US
Telephone Number	:	512-284-9278
Fax Number	:

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

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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