Provider Demographics
NPI:1689865115
Name:ALTER, JON ROBERT (D,C)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ROBERT
Last Name:ALTER
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 HOBSON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8648
Mailing Address - Country:US
Mailing Address - Phone:260-485-3146
Mailing Address - Fax:260-486-5278
Practice Address - Street 1:4222 HOBSON CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8648
Practice Address - Country:US
Practice Address - Phone:260-485-3146
Practice Address - Fax:260-486-5278
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000142A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1760527709OtherGROUP NUMBER
IN100081870BMedicaid
IN668900Medicare UPIN