Provider Demographics
NPI:1861438160
Name:ALTMAN, MILES FREDERICK JR (DC)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:FREDERICK
Last Name:ALTMAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W 38TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2350
Mailing Address - Country:US
Mailing Address - Phone:814-866-3366
Mailing Address - Fax:814-866-8877
Practice Address - Street 1:1455 W 38TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2350
Practice Address - Country:US
Practice Address - Phone:814-866-3366
Practice Address - Fax:814-866-8877
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
074977Medicare ID - Type Unspecified
U97569Medicare UPIN