Provider Demographics
NPI:1902176373
Name:LONG CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LONG CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-721-4496
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-0069
Mailing Address - Country:US
Mailing Address - Phone:662-721-4496
Mailing Address - Fax:662-721-4497
Practice Address - Street 1:810 E SUNFLOWER RD
Practice Address - Street 2:SUITE 100 E
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2800
Practice Address - Country:US
Practice Address - Phone:662-721-4496
Practice Address - Fax:662-721-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty