1679627459 NPI number — BILLY MIKEL LONG D.C.

Table of content: (NPI 1427927292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679627459 NPI number — BILLY MIKEL LONG D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
BILLY
Provider Middle Name:
MIKEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
BILLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679627459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24009 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE 235
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-591-8847
Provider Business Mailing Address Fax Number:
818-591-0549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24007 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-591-8847
Provider Business Practice Location Address Fax Number:
818-591-0549
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC27936 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC27936 . This is a "LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 202344792 . This is a "TAX ID #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64988Z . This is a "BC-BS GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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