Provider Demographics
NPI:1407080617
Name:MONTELLESE FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MONTELLESE FAMILY CHIROPRACTIC, INC.
Other - Org Name:MONTEREY BAY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONTELLESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-375-5151
Mailing Address - Street 1:PO BOX 2695
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-2695
Mailing Address - Country:US
Mailing Address - Phone:831-375-5151
Mailing Address - Fax:831-375-6682
Practice Address - Street 1:550 CAMINO EL ESTERO
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3231
Practice Address - Country:US
Practice Address - Phone:831-375-5151
Practice Address - Fax:831-375-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty