Provider Demographics
NPI:1780699447
Name:PERSON, LINNEA L (DC)
Entity type:Individual
Prefix:DR
First Name:LINNEA
Middle Name:L
Last Name:PERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1001
Mailing Address - Country:US
Mailing Address - Phone:815-539-3011
Mailing Address - Fax:815-539-7633
Practice Address - Street 1:1301 14TH AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1001
Practice Address - Country:US
Practice Address - Phone:815-539-3011
Practice Address - Fax:815-539-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37771Medicare UPIN
IL679830Medicare ID - Type Unspecified