Provider Demographics
NPI:1699715201
Name:LONG, ANATOLE M (DC)
Entity type:Individual
Prefix:DR
First Name:ANATOLE
Middle Name:M
Last Name:LONG
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 1:55 S 300 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737
Mailing Address - Country:US
Mailing Address - Phone:435-635-3828
Mailing Address - Fax:
Practice Address - Street 1:55 S 300 W
Practice Address - Street 2:SUITE 3
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737
Practice Address - Country:US
Practice Address - Phone:435-635-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176397-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor