Healthcare Provider Details

I. General information

NPI: 1073748430
Provider Name (Legal Business Name): DEVON LINTON DOM, AP, LAC, MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 31ST ST S STE B
ARLINGTON VA
22206-1663
US

IV. Provider business mailing address

4900 31ST ST S STE B
ARLINGTON VA
22206-1663
US

V. Phone/Fax

Practice location:
  • Phone: 703-855-3910
  • Fax: 703-933-8888
Mailing address:
  • Phone: 703-855-3910
  • Fax: 703-933-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2682
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number167931
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: