Provider Demographics
NPI:1013143445
Name:MONTROSE WELLNESS PA
Entity Type:Organization
Organization Name:MONTROSE WELLNESS PA
Other - Org Name:MONTROSE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-675-3121
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MN
Mailing Address - Zip Code:55363-0406
Mailing Address - Country:US
Mailing Address - Phone:763-675-3121
Mailing Address - Fax:763-675-3822
Practice Address - Street 1:145 NELSON BLVD, STE # 1000
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MN
Practice Address - Zip Code:55363
Practice Address - Country:US
Practice Address - Phone:763-675-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty