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Individual

DR. BRANDIE LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3008 W WILLOW KNOLLS DR STE C, PEORIA, IL 61614-1095
(309) 656-5664
Mailing address
8511 COUNTRY VIEW DR, MANITO, IL 61546-8619
(309) 678-0963

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
IL
111N00000X
Chiropractor
Primary
038012626
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1001001001
DONT HAVE
IL
Enumeration date
01/31/2018
Last updated
05/07/2026
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