Provider Demographics
NPI:1124165352
Name:MONTELEONE, DOUGLAS F (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:F
Last Name:MONTELEONE
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 1:820 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-283-7979
Mailing Address - Fax:716-283-1336
Practice Address - Street 1:820 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-283-7979
Practice Address - Fax:716-283-1336
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006652-1111N00000X
NYX006652-4111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7292Medicare PIN
NYU-25257Medicare UPIN
NYCC7292Medicare PIN