Provider Demographics
NPI:1932213220
Name:ALTHARDT, RONALD THEODORE (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:THEODORE
Last Name:ALTHARDT
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 1:203 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1810
Mailing Address - Country:US
Mailing Address - Phone:618-664-3001
Mailing Address - Fax:618-664-1898
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1810
Practice Address - Country:US
Practice Address - Phone:618-664-3001
Practice Address - Fax:618-664-1898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL292470Medicare ID - Type UnspecifiedMEDICARE