Provider Demographics
NPI:1992714547
Name:ALTAKALI, SAL S (DC)
Entity type:Individual
Prefix:DR
First Name:SAL
Middle Name:S
Last Name:ALTAKALI
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 1:322 S FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1106
Mailing Address - Country:US
Mailing Address - Phone:210-222-0999
Mailing Address - Fax:210-222-8399
Practice Address - Street 1:322 S FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1106
Practice Address - Country:US
Practice Address - Phone:210-222-0999
Practice Address - Fax:210-222-8399
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17459601Medicaid
TX8D3237Medicare ID - Type Unspecified