Provider Demographics
NPI:1487086070
Name:LONGYEAR, MICHAEL AGOSTINO (DC, CCSP, DACNB)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AGOSTINO
Last Name:LONGYEAR
Suffix:
Gender:M
Credentials:DC, CCSP, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2943
Mailing Address - Country:US
Mailing Address - Phone:904-900-1477
Mailing Address - Fax:
Practice Address - Street 1:8750 PERIMETER PARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2287
Practice Address - Country:US
Practice Address - Phone:904-900-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12881111NN0400X
NC4419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE 568 B 621Medicare UPIN