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General NPI Number Information
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NPI Number | 1336320647
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Entity Type | Individual
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Provider Name | JOSHUA LEE ALTWINE D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 1001 N BUCKNER ST
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City | DERBY
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State | KS
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Zip | 67037-1824
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Country | US
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Telephone | 316-788-7500
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Fax | 316-788-7702
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Provider Business Mailing Address
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Address Line | 1001 N BUCKNER ST
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City | DERBY
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State | KS
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Zip | 67037-1824
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Country | US
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Telephone | 316-788-7500
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Fax | 316-788-7702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0105297
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License Number State | KS
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