Provider Demographics
NPI:1497276448
Name:WALL, LINDA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:WALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 HUFFMAN PARK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3534
Mailing Address - Country:US
Mailing Address - Phone:907-222-6122
Mailing Address - Fax:907-205-5740
Practice Address - Street 1:1389 HUFFMAN PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3534
Practice Address - Country:US
Practice Address - Phone:907-222-6122
Practice Address - Fax:907-205-5740
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121838111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation