Provider Demographics
NPI:1285002709
Name:RST & MONTGOMERY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RST & MONTGOMERY CHIROPRACTIC, INC.
Other - Org Name:REDDING SPORTS THERAPY & CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEALOHANANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-247-4228
Mailing Address - Street 1:2335 ATHENS AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2818
Mailing Address - Country:US
Mailing Address - Phone:530-247-4228
Mailing Address - Fax:530-247-4275
Practice Address - Street 1:2335 ATHENS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2818
Practice Address - Country:US
Practice Address - Phone:530-247-4228
Practice Address - Fax:530-247-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31642111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFT549AMedicare UPIN