Provider Demographics
NPI:1790702496
Name:LINZNER, ERWIN (DC)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:LINZNER
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 1:1551 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3568
Mailing Address - Country:US
Mailing Address - Phone:707-586-5555
Mailing Address - Fax:707-303-4377
Practice Address - Street 1:1551 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3568
Practice Address - Country:US
Practice Address - Phone:707-586-5555
Practice Address - Fax:707-303-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0232990Medicare ID - Type Unspecified
CAU59695Medicare UPIN