Provider Demographics
NPI:1407930787
Name:DENHAM, LINDA S (DC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:DENHAM
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 1:205 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3660
Mailing Address - Country:US
Mailing Address - Phone:770-368-2597
Mailing Address - Fax:770-387-1031
Practice Address - Street 1:205 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3660
Practice Address - Country:US
Practice Address - Phone:770-368-2597
Practice Address - Fax:770-387-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00490234AMedicaid
GAT97541Medicare UPIN