Provider Demographics
NPI:1770510562
Name:MONTELLESE, KRISTINA E (DC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:MONTELLESE
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:PO BOX 2695
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-2695
Mailing Address - Country:US
Mailing Address - Phone:831-655-3255
Mailing Address - Fax:831-655-3443
Practice Address - Street 1:550 CAMINO EL ESTERO
Practice Address - Street 2:SUITE 103
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3231
Practice Address - Country:US
Practice Address - Phone:831-655-3255
Practice Address - Fax:831-655-3443
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV812AMedicare UPIN