Provider Demographics
NPI:1497157994
Name:ALTORELLI, MYLES DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:DAVID
Last Name:ALTORELLI
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 1:125 NEW MILFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777-1703
Mailing Address - Country:US
Mailing Address - Phone:860-868-6880
Mailing Address - Fax:860-868-7310
Practice Address - Street 1:125 NEW MILFORD TPKE
Practice Address - Street 2:
Practice Address - City:NEW PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06777-1703
Practice Address - Country:US
Practice Address - Phone:860-868-6880
Practice Address - Fax:860-868-7310
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor