Provider Demographics
NPI:1134236946
Name:ALTMAN, DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ALTMAN
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 1:860 111TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1829
Mailing Address - Country:US
Mailing Address - Phone:239-260-5644
Mailing Address - Fax:239-260-5644
Practice Address - Street 1:860 111TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1829
Practice Address - Country:US
Practice Address - Phone:239-260-5644
Practice Address - Fax:239-260-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7643111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381798900Medicaid
FL88546OtherBCBS OF FLORIDA
FLU85018Medicare UPIN
FL88546Medicare ID - Type Unspecified