Provider Demographics
NPI:1891911178
Name:ALTAMIRANO, JOSE R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:ALTAMIRANO
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 1:18 DOWNS ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4722
Mailing Address - Country:US
Mailing Address - Phone:203-743-4042
Mailing Address - Fax:203-744-3081
Practice Address - Street 1:18 DOWNS ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4722
Practice Address - Country:US
Practice Address - Phone:203-743-4042
Practice Address - Fax:203-744-3081
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1167111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation