Provider Demographics
NPI:1336320647
Name:ALTWINE, JOSHUA LEE (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:ALTWINE
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 1:1001 N BUCKNER ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1824
Mailing Address - Country:US
Mailing Address - Phone:316-788-7500
Mailing Address - Fax:316-788-7702
Practice Address - Street 1:1001 N BUCKNER ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1824
Practice Address - Country:US
Practice Address - Phone:316-788-7500
Practice Address - Fax:316-788-7702
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor