Individual
LISA R LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
307 E KARSCH BLVD, FARMINGTON, MO 63640-1203
(573) 760-1515
(573) 760-0817
Mailing address
307 E KARSCH BLVD, FARMINGTON, MO 63640-1203
(573) 760-1515
(573) 760-0817
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5812
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10410T002
COVENTRY HEALTH
MO
01
—
105957
BC/BS OF MISSOURI
MO
01
—
T2448
MERCY HEALTH PLANS
MO
Enumeration date
08/19/2005
Last updated
05/06/2008
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