Provider Demographics
NPI:1982744421
Name:PORTO, LINDA MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARY
Last Name:PORTO
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 1:15 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8147
Mailing Address - Country:US
Mailing Address - Phone:203-794-1049
Mailing Address - Fax:203-730-9721
Practice Address - Street 1:15 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8147
Practice Address - Country:US
Practice Address - Phone:203-794-1049
Practice Address - Fax:203-730-9721
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004089349Medicaid
CT004089349Medicaid
CTT91664Medicare UPIN