Provider Demographics
NPI:1073202461
Name:ALTUS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALTUS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYEB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-330-8788
Mailing Address - Street 1:4207 S DALE MABRY HWY UNIT 3203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1433
Mailing Address - Country:US
Mailing Address - Phone:312-330-8788
Mailing Address - Fax:855-835-5789
Practice Address - Street 1:3030 N ROCKY POINT DR W STE 161
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7201
Practice Address - Country:US
Practice Address - Phone:312-330-8878
Practice Address - Fax:855-835-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty