Provider Demographics
NPI:1275517500
Name:MONTGOMERY, THOMAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
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 1:148 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1432
Mailing Address - Country:US
Mailing Address - Phone:330-638-7310
Mailing Address - Fax:330-638-7257
Practice Address - Street 1:148 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1432
Practice Address - Country:US
Practice Address - Phone:330-638-7310
Practice Address - Fax:330-638-7257
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH812111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0474768Medicaid
OH0482503Medicare PIN
OH0474768Medicaid