Provider Demographics
NPI:1821162660
Name:ALTER, STEPHEN A (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
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 1:6131 HURSH RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8801
Mailing Address - Country:US
Mailing Address - Phone:260-627-8495
Mailing Address - Fax:
Practice Address - Street 1:10331 DAWSONS CREEK BLVD
Practice Address - Street 2:BLDG. 8, SUITE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1908
Practice Address - Country:US
Practice Address - Phone:260-497-0999
Practice Address - Fax:260-497-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001217A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor