Provider Demographics
NPI:1194894501
Name:LINTON, LORAL G (DC)
Entity type:Individual
Prefix:DR
First Name:LORAL
Middle Name:G
Last Name:LINTON
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 1:662 S HWY. 89A
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3646
Mailing Address - Country:US
Mailing Address - Phone:435-644-2459
Mailing Address - Fax:435-644-2463
Practice Address - Street 1:662 S HWY. 89A
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3646
Practice Address - Country:US
Practice Address - Phone:435-644-2459
Practice Address - Fax:435-644-2463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160333-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78030Medicare UPIN