MEDICARE: DR. JORDAN MICHELLE 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	111N00000X	Chiropractor	007733	IA

General Provider Information

NPI Number	:	1750781282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN MICHELLE LONG D.C

Provider Business Mailing Address
First Line	:	2140 NORCOR AVE
Second Line	:	SUITE D
City	:	CORALVILLE
State	:	IA
Zip	:	52241-9736
Country	:	US
Telephone Number	:	319-354-4186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 NORCOR AVE
Second Line	:	SUITE D
City	:	CORALVILLE
State	:	IA
Zip	:	52241-9736
Country	:	US
Telephone Number	:	319-354-4186
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	04/20/2015

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