Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4772-012 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 5509 | MN |
NPI | 1174812473 |
---|---|
Provider Name | Casey Jeanne Long |
First Address | Wittenberg, WI 54499-9196 |
Second Address | Wausau, WI 54401-3958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 13/07/2020 |