Dr. Jack A Long, D.C.
Chiropractor in Meridian, ID. Individual provider (NPI-1).
NPI number1184792129
StatusActive
Last updated in NPPESJul 9, 2007
Details
- NPI
- 1184792129
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jack A Long
- Credential
- D.C.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 30, 2006
- Last updated
- Jul 9, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | Chia-352 | ID | Yes |
Practice location
2893 E Green Canyon DrMeridian, ID 83642-9105
Phone 208-850-6511 · Fax 208-888-3882
Mailing address
2893 E Green Canyon DrMeridian, ID 83642-9105
Phone 208-850-6511 · Fax 208-888-3882
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