Provider Demographics
NPI:1174661383
Name:MONTGOMERY, PATRICK RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RICHARD
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:RICHARD
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1004 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7909
Mailing Address - Country:US
Mailing Address - Phone:406-721-4588
Mailing Address - Fax:406-721-1078
Practice Address - Street 1:1004 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7909
Practice Address - Country:US
Practice Address - Phone:406-721-4588
Practice Address - Fax:406-721-1078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor