Provider Demographics
NPI:1043242845
Name:DR. CORY H. ALTABET
Entity Type:Organization
Organization Name:DR. CORY H. ALTABET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALTABET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-337-0070
Mailing Address - Street 1:18471 SMOCK HWY
Mailing Address - Street 2:SPACE 2
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-337-0070
Mailing Address - Fax:814-337-0300
Practice Address - Street 1:18471 SMOCK HWY
Practice Address - Street 2:SPACE 2
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-337-0070
Practice Address - Fax:814-337-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005204L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014846060002Medicaid
PA764798Medicare ID - Type Unspecified
PAU51347Medicare UPIN