Provider Demographics
NPI:1861930620
Name:LONG, BETHANY PAIGE (DC)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:PAIGE
Last Name:LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3495
Mailing Address - Country:US
Mailing Address - Phone:913-735-6854
Mailing Address - Fax:
Practice Address - Street 1:5001 COLLEGE BLVD # 102
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1932
Practice Address - Country:US
Practice Address - Phone:913-735-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor