Provider Demographics
NPI:1619276359
Name:MONTICELLO CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MONTICELLO CHIROPRACTIC PLLC
Other - Org Name:NORMA E ESPARZA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-336-9355
Mailing Address - Street 1:PO BOX 471669
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76147-1401
Mailing Address - Country:US
Mailing Address - Phone:817-336-9355
Mailing Address - Fax:
Practice Address - Street 1:2701 W BERRY ST
Practice Address - Street 2:STE. 130
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2360
Practice Address - Country:US
Practice Address - Phone:817-336-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty