Provider Demographics
NPI:1598016537
Name:LINO, MYRON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:LEE
Last Name:LINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2693 VININGS CENTRAL DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6788
Mailing Address - Country:US
Mailing Address - Phone:404-200-2045
Mailing Address - Fax:
Practice Address - Street 1:3000 WINDY HILL RD SE
Practice Address - Street 2:SUITE 180
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8478
Practice Address - Country:US
Practice Address - Phone:678-310-7080
Practice Address - Fax:770-783-6329
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor