Provider Demographics
NPI:1861746323
Name:LI, LINDA M (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:LI
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:PO BOX 20990
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-3990
Mailing Address - Country:US
Mailing Address - Phone:303-443-1342
Mailing Address - Fax:303-443-1350
Practice Address - Street 1:4860 RIVERBEND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2614
Practice Address - Country:US
Practice Address - Phone:303-443-1342
Practice Address - Fax:303-443-1350
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3022111NN1001X
NYX002078111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition