Provider Demographics
NPI:1821162827
Name:ALTIERI, JEANETTE (DC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SCENIC HWY # 124
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5621
Mailing Address - Country:US
Mailing Address - Phone:770-851-8922
Mailing Address - Fax:770-513-0547
Practice Address - Street 1:217 SCENIC HWY # 124
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5621
Practice Address - Country:US
Practice Address - Phone:770-851-8922
Practice Address - Fax:770-513-0547
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO04727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP403Medicare ID - Type Unspecified