Provider Demographics
NPI:1477747889
Name:ALTER, MICHAEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:ALTER
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 1:1741 MORNINGSTAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-3810
Mailing Address - Country:US
Mailing Address - Phone:260-724-8884
Mailing Address - Fax:260-724-8883
Practice Address - Street 1:1741 MORNINGSTAR BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-3810
Practice Address - Country:US
Practice Address - Phone:260-724-8884
Practice Address - Fax:260-724-8883
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001428A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100081870AMedicaid
IN230760BMedicare PIN