Provider Demographics
NPI:1679018501
Name:LINO, ANTHONY-JARED (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY-JARED
Middle Name:
Last Name:LINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5818
Mailing Address - Country:US
Mailing Address - Phone:440-255-9355
Mailing Address - Fax:440-255-3410
Practice Address - Street 1:8515 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5818
Practice Address - Country:US
Practice Address - Phone:440-255-9355
Practice Address - Fax:440-255-3410
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor