Provider Demographics
NPI:1669719498
Name:MONTGOMERY XPRESS CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:MONTGOMERY XPRESS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, STAFF DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-787-7529
Mailing Address - Street 1:116 E HERITAGE DR
Mailing Address - Street 2:STE 105
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5150
Mailing Address - Country:US
Mailing Address - Phone:903-787-7529
Mailing Address - Fax:903-787-7530
Practice Address - Street 1:116 E HERITAGE DR.
Practice Address - Street 2:STE 105
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5159
Practice Address - Country:US
Practice Address - Phone:903-787-7529
Practice Address - Fax:903-787-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care