Provider Demographics
NPI:1851481287
Name:MONTECALVO, NICOLO (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLO
Middle Name:
Last Name:MONTECALVO
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 1:10620 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9372
Mailing Address - Country:US
Mailing Address - Phone:208-476-3158
Mailing Address - Fax:502-222-9749
Practice Address - Street 1:10620 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9372
Practice Address - Country:US
Practice Address - Phone:208-476-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001709Medicaid
KYU77889Medicare UPIN
KY85001709Medicaid