Provider Demographics
NPI:1174812473
Name:LONG, CASEY JEANNE (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JEANNE
Last Name:LONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:JEANNE
Other - Last Name:CESSNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:500 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9196
Mailing Address - Country:US
Mailing Address - Phone:715-253-2239
Mailing Address - Fax:715-253-3331
Practice Address - Street 1:601 S 32ND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3958
Practice Address - Country:US
Practice Address - Phone:715-848-1741
Practice Address - Fax:715-848-2225
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5509111NS0005X
WI4772-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician