MEDICARE: DR. JODI LAUREN ALTMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B00674	NV

General Provider Information

NPI Number	:	1336458835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI LAUREN ALTMAN D.C.

Provider Business Mailing Address
First Line	:	7835 S RAINBOW BLVD
Second Line	:	SUITE 15
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6455
Country	:	US
Telephone Number	:	702-732-0000
Fax Number	:	702-255-7333

Provider Business Practice Location Address
First Line	:	7835 S RAINBOW BLVD
Second Line	:	SUITE 15
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6455
Country	:	US
Telephone Number	:	702-732-0000
Fax Number	:	702-255-7333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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