Individual
DR. JACK A LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2893 E GREEN CANYON DR, MERIDIAN, ID 83642-9105
(208) 850-6511
(208) 888-3882
Mailing address
2893 E GREEN CANYON DR, MERIDIAN, ID 83642-9105
(208) 850-6511
(208) 888-3882
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-352
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0025046
—
ID
Enumeration date
11/30/2006
Last updated
07/09/2007
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