Provider Demographics
NPI:1811233703
Name:MONTGOMERY, MATTHEW H (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:H
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 1:116 E HERITAGE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5159
Mailing Address - Country:US
Mailing Address - Phone:903-787-7529
Mailing Address - Fax:
Practice Address - Street 1:116 E HERITAGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5150
Practice Address - Country:US
Practice Address - Phone:903-787-7529
Practice Address - Fax:903-787-7530
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor