Provider Demographics
NPI:1396241394
Name:LONGORIA, JEROME ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ALEXANDER
Last Name:LONGORIA
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 1:3192 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2239
Mailing Address - Country:US
Mailing Address - Phone:928-288-0500
Mailing Address - Fax:928-432-7003
Practice Address - Street 1:3192 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2239
Practice Address - Country:US
Practice Address - Phone:928-288-0500
Practice Address - Fax:928-432-7003
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor