Provider Demographics
NPI:1104902709
Name:LONGMAN, JEFFREY JOHN (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:LONGMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8889
Mailing Address - Country:US
Mailing Address - Phone:910-686-6508
Mailing Address - Fax:910-686-8416
Practice Address - Street 1:8207 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8889
Practice Address - Country:US
Practice Address - Phone:910-686-6508
Practice Address - Fax:910-686-8416
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085A0OtherBLUE CROSS BLUE SHIELD
NC662948OtherACN
NC2454025Medicare ID - Type Unspecified
NC085A0OtherBLUE CROSS BLUE SHIELD