Provider Demographics
NPI:1053351296
Name:CARTY, LINDA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:CARTY
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 1:1183 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4049
Mailing Address - Country:US
Mailing Address - Phone:909-946-6407
Mailing Address - Fax:909-946-6714
Practice Address - Street 1:1183 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4049
Practice Address - Country:US
Practice Address - Phone:909-946-6407
Practice Address - Fax:909-946-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0186590OtherMEDICARE PTAN
CAT06726Medicare UPIN