Provider Demographics
NPI:1598957649
Name:ALTMAN, DAVID L (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:ALTMAN
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 1:41 N RIO GRANDE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1276
Mailing Address - Country:US
Mailing Address - Phone:801-896-3259
Mailing Address - Fax:
Practice Address - Street 1:41 N RIO GRANDE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1276
Practice Address - Country:US
Practice Address - Phone:801-896-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003607111N00000X
UT7814004-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU70828Medicare UPIN
UT350001745Medicare PIN