Provider Demographics
NPI:1558952549
Name:360 NORTH LINDON CLINIC LLC
Entity Type:Organization
Organization Name:360 NORTH LINDON CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-FERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-4283
Mailing Address - Street 1:360 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1834
Mailing Address - Country:US
Mailing Address - Phone:801-427-9779
Mailing Address - Fax:385-238-4166
Practice Address - Street 1:360 N STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1834
Practice Address - Country:US
Practice Address - Phone:801-427-9779
Practice Address - Fax:385-238-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty