Provider Demographics
NPI:1891758108
Name:ALTMAN, JAMES GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3400
Mailing Address - Country:US
Mailing Address - Phone:863-767-1019
Mailing Address - Fax:863-767-1023
Practice Address - Street 1:431 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3400
Practice Address - Country:US
Practice Address - Phone:863-767-1019
Practice Address - Fax:863-767-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL652544OtherUNITED HEALTH
FL55918ZMedicare PIN
FL79378Medicare UPIN