Provider Demographics
NPI:1326187832
Name:MONTELEON, JEFFREY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:MONTELEON
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 1:1066 CITRUS AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4847
Mailing Address - Country:US
Mailing Address - Phone:321-409-0209
Mailing Address - Fax:321-409-0208
Practice Address - Street 1:5560 BABCOCK ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2300
Practice Address - Country:US
Practice Address - Phone:321-409-0209
Practice Address - Fax:321-409-0208
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381841100Medicaid