Individual provider Active NPI

Douglas M Long, D.C.

  • Chiropractor
  • Tacoma, WA
National Provider Identifier
1902904006
Registry record updated Oct 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002925 Issued in WA
Practice address
4902 Tacoma Mall Blvd
Tacoma, WA 98409-7149
Phone
(253) 473-0300
Fax
(253) 473-0305
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00002925 WA Primary

Addresses

Primary practice location

4902 Tacoma Mall Blvd
Tacoma, WA 98409-7149

Mailing address

4902 Tacoma Mall Blvd
Tacoma, WA 98409-7149
Phone (253) 473-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120306000309 WA Practitioner - Chiropractic 6507752516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 1993
Medicare assignment
May accept Medicare assignment
Group practices
RCC PSGroup PAC ID 8022376920, 6 clinicians

Practice addresses (Care Compare)

4902 Tacoma Mall Blvd
Tacoma, WA 98409-7149
Phone (253) 473-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1902904006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4902 TACOMA MALL BLVD",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097149",
            "telephone_number": "253-473-0300",
            "fax_number": "253-473-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4902 TACOMA MALL BLVD",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097149",
            "telephone_number": "253-473-0300",
            "fax_number": "253-473-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "DOUGLAS",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.