Provider Demographics
NPI:1033149521
Name:LIN, JEFFREY C (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:LIN
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 1:1260 HAMNER AVE
Mailing Address - Street 2:STE E
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3136
Mailing Address - Country:US
Mailing Address - Phone:951-808-8320
Mailing Address - Fax:951-808-8313
Practice Address - Street 1:1260 HAMNER AVE
Practice Address - Street 2:STE E
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3136
Practice Address - Country:US
Practice Address - Phone:951-808-8320
Practice Address - Fax:951-808-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01608Medicare UPIN
CADC0286950Medicare ID - Type Unspecified