Provider Demographics
NPI:1508393083
Name:LICHTER, MONTANA (DC)
Entity Type:Individual
Prefix:DR
First Name:MONTANA
Middle Name:
Last Name:LICHTER
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 1:1151 BLACKWOOD AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4523
Mailing Address - Country:US
Mailing Address - Phone:321-234-8900
Mailing Address - Fax:
Practice Address - Street 1:1151 BLACKWOOD AVE STE 170
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4523
Practice Address - Country:US
Practice Address - Phone:321-234-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor