Provider Demographics
NPI:1912271073
Name:DR LORAL G LINTON DC PROFESSIONAL CORP.
Entity type:Organization
Organization Name:DR LORAL G LINTON DC PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORAL
Authorized Official - Middle Name:G
Authorized Official - Last Name:LINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-644-5296
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:435-644-5296
Mailing Address - Fax:435-644-5296
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:435-644-5296
Practice Address - Fax:435-644-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160333-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78030Medicare UPIN
UTU000005630Medicare PIN