Provider Demographics
NPI:1336662568
Name:STANLEY, MONTGOMERY AMBERSON (DC)
Entity Type:Individual
Prefix:
First Name:MONTGOMERY
Middle Name:AMBERSON
Last Name:STANLEY
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 1:6410 TERRELL DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6650
Mailing Address - Country:US
Mailing Address - Phone:662-684-9298
Mailing Address - Fax:662-684-9298
Practice Address - Street 1:3435 BRANARD ST STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6057
Practice Address - Country:US
Practice Address - Phone:281-810-7394
Practice Address - Fax:281-810-7394
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor