Provider Demographics
NPI:1942354709
Name:MONTZ-GOBLE, KRISTY JO (DC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:MONTZ-GOBLE
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 1:16500 STATE HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-4115
Mailing Address - Country:US
Mailing Address - Phone:417-847-5081
Mailing Address - Fax:417-847-1911
Practice Address - Street 1:16500 STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-4115
Practice Address - Country:US
Practice Address - Phone:417-847-5081
Practice Address - Fax:417-847-1911
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3086OtherANTHEM BCBS
MO000031042Medicare ID - Type Unspecified