Provider Demographics
NPI:1558846022
Name:MONTANA, JENNA FLORENCE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:FLORENCE
Last Name:MONTANA
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 1:1917 BURMA RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2329
Mailing Address - Country:US
Mailing Address - Phone:727-207-1536
Mailing Address - Fax:
Practice Address - Street 1:2702 BRAMBLETON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4308
Practice Address - Country:US
Practice Address - Phone:540-755-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor