Provider Demographics
NPI:1700320900
Name:LONG, DANIEL JR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LONG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2212
Mailing Address - Country:US
Mailing Address - Phone:206-242-0998
Mailing Address - Fax:206-244-3962
Practice Address - Street 1:514 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4335
Practice Address - Country:US
Practice Address - Phone:253-850-2225
Practice Address - Fax:253-850-5757
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60708990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor