Provider Demographics
NPI:1255533139
Name:MEDLONG, ABRAHAM BROWN (DC)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:BROWN
Last Name:MEDLONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 PEARL RD
Mailing Address - Street 2:200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4234
Mailing Address - Country:US
Mailing Address - Phone:216-739-9000
Mailing Address - Fax:216-739-9001
Practice Address - Street 1:4269 PEARL RD
Practice Address - Street 2:200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4234
Practice Address - Country:US
Practice Address - Phone:216-739-9000
Practice Address - Fax:216-739-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010958111N00000X
OH3883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor