Provider Demographics
NPI:1962546168
Name:ATKINSON, LINDA MAE (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MAE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2914
Mailing Address - Country:US
Mailing Address - Phone:313-330-7100
Mailing Address - Fax:313-383-0415
Practice Address - Street 1:4828 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2914
Practice Address - Country:US
Practice Address - Phone:313-330-7100
Practice Address - Fax:313-383-0415
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI142745860OtherOMNI HEALTH PLAN
MI950E019790OtherBCBSM
MI2745860Medicaid
MI350021698OtherMEDICARE UNITED HEALTH CA
MIP86321OtherBLUE CARE NETWORK
MIP86321Medicare UPIN
MI0Q25123Medicare ID - Type Unspecified