Provider Demographics
NPI:1164835864
Name:MONTILLA, REBECCA ELAINE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELAINE
Last Name:MONTILLA
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 1:7446 SHALLOWFORD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8815
Mailing Address - Country:US
Mailing Address - Phone:407-733-3411
Mailing Address - Fax:
Practice Address - Street 1:7446 SHALLOWFORD RD STE 204
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8815
Practice Address - Country:US
Practice Address - Phone:407-733-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor