Provider Demographics
NPI:1528384625
Name:MONTGOMERY, AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:MONTGOMERY
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 1:1450 NE VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3827
Mailing Address - Country:US
Mailing Address - Phone:503-983-6497
Mailing Address - Fax:503-512-5420
Practice Address - Street 1:1304 NW CIVIC DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5569
Practice Address - Country:US
Practice Address - Phone:503-512-1040
Practice Address - Fax:503-662-7334
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor