Provider Demographics
NPI:1881628899
Name:MONTGOMERY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MONTGOMERY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:REWEL
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-939-5801
Mailing Address - Street 1:401 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2667
Mailing Address - Country:US
Mailing Address - Phone:254-939-5801
Mailing Address - Fax:254-939-2229
Practice Address - Street 1:401 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2667
Practice Address - Country:US
Practice Address - Phone:254-939-5801
Practice Address - Fax:254-939-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041JFOtherBC/BS GROUP ID#
00915TMedicare PIN