Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC006842-L | PA |
N | 111NX0100X | Occupational Health | DC006842-L | PA |
NPI | 1114022100 |
---|---|
Provider Name | Dr. Kevin L. Long |
First Address | Lancaster, PA 17603-4012 |
Second Address | Lancaster, PA 17603-4012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LO445351 | HIGHMARK PROVIDER NUMBER (01) | PA |
U63694 | (02) | PA |