Provider Demographics
NPI:1942216767
Name:MONTEMAYOR, VIVIAN (DC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2510
Mailing Address - Country:US
Mailing Address - Phone:727-807-7020
Mailing Address - Fax:727-807-7021
Practice Address - Street 1:5323 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2510
Practice Address - Country:US
Practice Address - Phone:727-807-7020
Practice Address - Fax:727-807-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLV05984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV05984Medicare UPIN