Provider Demographics
NPI:1700072519
Name:ALTMAN, BECKY
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 E STATE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2589
Mailing Address - Country:US
Mailing Address - Phone:801-642-4199
Mailing Address - Fax:
Practice Address - Street 1:456 E STATE RD STE 500
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2589
Practice Address - Country:US
Practice Address - Phone:801-642-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7835566-1202111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN987718500Medicaid
MNU76843Medicare UPIN
MN987718500Medicaid