Provider Demographics
NPI:1154454270
Name:MONTGOMERY, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:MONTGOMERY
Suffix:
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 1:1851 SCHOETTLER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5529
Mailing Address - Country:US
Mailing Address - Phone:636-227-2100
Mailing Address - Fax:636-207-2424
Practice Address - Street 1:1851 SCHOETTLER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5529
Practice Address - Country:US
Practice Address - Phone:636-227-2100
Practice Address - Fax:636-207-2424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor