Provider Demographics
NPI:1508092958
Name:MONTEIRO, AUTUMN LYNN (DC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LYNN
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 DIAMOND FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5701
Mailing Address - Country:US
Mailing Address - Phone:702-591-5610
Mailing Address - Fax:
Practice Address - Street 1:6090 S FORT APACHE RD
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5617
Practice Address - Country:US
Practice Address - Phone:702-591-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor