Provider Demographics
NPI:1164870804
Name:LINFORD CHIROPRACTIC VACATION SERVICES
Entity Type:Organization
Organization Name:LINFORD CHIROPRACTIC VACATION SERVICES
Other - Org Name:LINFORD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-388-2101
Mailing Address - Street 1:6535 S WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-6140
Mailing Address - Country:US
Mailing Address - Phone:801-388-2101
Mailing Address - Fax:
Practice Address - Street 1:8822 S REDWOOD RD STE C212
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5692
Practice Address - Country:US
Practice Address - Phone:801-388-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6139191-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty