Provider Demographics
NPI:1639332679
Name:ALTAMIRANO CHIROPRACTIC
Entity Type:Organization
Organization Name:ALTAMIRANO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:3105-138-0529
Mailing Address - Street 1:601 N AVALON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5807
Mailing Address - Country:US
Mailing Address - Phone:310-513-8059
Mailing Address - Fax:310-513-9247
Practice Address - Street 1:601 N AVALON BLVD STE D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5807
Practice Address - Country:US
Practice Address - Phone:310-513-8059
Practice Address - Fax:310-513-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27714Medicare PIN