Provider Demographics
NPI:1700949922
Name:PINTO, ALFRED LOUIS (DC)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LOUIS
Last Name:PINTO
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 1:229 RED COACH DR
Mailing Address - Street 2:STE 106
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3195
Mailing Address - Country:US
Mailing Address - Phone:574-254-1400
Mailing Address - Fax:574-254-1650
Practice Address - Street 1:212 W EDISON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8301
Practice Address - Country:US
Practice Address - Phone:574-254-1400
Practice Address - Fax:574-254-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN008001788A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200174450Medicaid
IN200174450Medicaid
IN239350BMedicare ID - Type Unspecified