Provider Demographics
NPI:1912075177
Name:LONGVIEW CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:LONGVIEW CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GARTLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:919-212-1505
Mailing Address - Street 1:2116 10B NEW BERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-212-1505
Mailing Address - Fax:919-212-1492
Practice Address - Street 1:2116 10B NEW BERN AVENUE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-212-1505
Practice Address - Fax:919-212-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JEMedicaid
U90033Medicare UPIN
2454962AMedicare ID - Type Unspecified