Individual
DR. GARY D LONGSHORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12044 BALD HILL RD SE, YELM, WA 98597-9664
(360) 943-4113
(360) 455-4112
Mailing address
12044 BALD HILL RD SE, YELM, WA 98597-9664
(360) 458-9812
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH3400
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188260
L&I ID NUMBER
WA
01
—
609947
ACN ACCOUNT NUMBER
WA
Enumeration date
03/02/2007
Last updated
07/09/2007
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