Provider Demographics
NPI:1134588841
Name:MONTIE, ERIC (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MONTIE
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 1:105 BAKER ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1111
Mailing Address - Country:US
Mailing Address - Phone:608-393-4596
Mailing Address - Fax:
Practice Address - Street 1:105 BAKER ST
Practice Address - Street 2:STE 1
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1111
Practice Address - Country:US
Practice Address - Phone:608-393-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor