Healthcare Provider Details

I. General information

NPI: 1497157994
Provider Name (Legal Business Name): MYLES DAVID ALTORELLI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NEW MILFORD TPKE
NEW PRESTON CT
06777-1703
US

IV. Provider business mailing address

125 NEW MILFORD TPKE
NEW PRESTON CT
06777-1703
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-6880
  • Fax: 860-868-7310
Mailing address:
  • Phone: 860-868-6880
  • Fax: 860-868-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1987
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: