Provider Demographics
NPI:1336458835
Name:ALTMAN, JODI LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LAUREN
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6455
Mailing Address - Country:US
Mailing Address - Phone:702-732-0000
Mailing Address - Fax:702-255-7333
Practice Address - Street 1:7835 S RAINBOW BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6455
Practice Address - Country:US
Practice Address - Phone:702-732-0000
Practice Address - Fax:702-255-7333
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor