Provider Demographics
NPI:1417226168
Name:ALTMANN, BENJAMIN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:ALTMANN
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 1:540 VILLAGE WALK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9554
Mailing Address - Country:US
Mailing Address - Phone:920-699-8600
Mailing Address - Fax:920-699-0099
Practice Address - Street 1:540 VILLAGE WALK LN
Practice Address - Street 2:SUITE B
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9554
Practice Address - Country:US
Practice Address - Phone:920-699-8600
Practice Address - Fax:920-699-0099
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor