Healthcare Provider Details

I. General information

NPI: 1720170392
Provider Name (Legal Business Name): EDWARD ALTMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2878
US

IV. Provider business mailing address

9412 INDIAN SCHOOL ROAD
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-7371
  • Fax: 505-298-7326
Mailing address:
  • Phone: 505-298-7371
  • Fax: 505-298-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1403
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: