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General NPI Number Information
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NPI Number | 1285700955
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Entity Type | Organization
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Legal Business Name | DALE R. ALT, D.C., S.C.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 127 PARK AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-2107
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Country | US
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Telephone | 920-887-3717
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Fax | 920-887-0220
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Provider Business Mailing Address
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Address Line | 127 PARK AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-2107
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Country | US
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Telephone | 920-887-3717
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Fax | 920-887-0220
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE RAYMOND ALT
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Credential | DC
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Telephone | 920-887-3717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2007-012
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License Number State | WI
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