Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC008820 | PA |
NPI | 1255372314 |
---|---|
Provider Name | Dr. David Long |
First Address | Philadelphia, PA 19119-3647 |
Second Address | Horsham, PA 19044-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |