Provider Demographics
NPI:1881052819
Name:MONTIE ENTERPRISES LLC
Entity type:Organization
Organization Name:MONTIE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MONTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-393-4596
Mailing Address - Street 1:E10838 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9766
Mailing Address - Country:US
Mailing Address - Phone:608-393-4596
Mailing Address - Fax:
Practice Address - Street 1:E10838 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9766
Practice Address - Country:US
Practice Address - Phone:608-393-4596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5165-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty