Provider Demographics
NPI:1538609557
Name:ALT, CHUCK
Entity type:Individual
Prefix:
First Name:CHUCK
Middle Name:
Last Name:ALT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3979
Mailing Address - Country:US
Mailing Address - Phone:217-443-0682
Mailing Address - Fax:217-443-8358
Practice Address - Street 1:710 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3979
Practice Address - Country:US
Practice Address - Phone:217-443-0682
Practice Address - Fax:217-443-8358
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEH011992237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist