Provider Demographics
NPI:1881938413
Name:AUTUMN L MONTEIRO, DC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:AUTUMN L MONTEIRO, DC A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-834-5777
Mailing Address - Street 1:6090 S FORT APACHE RD
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5658
Mailing Address - Country:US
Mailing Address - Phone:702-834-5777
Mailing Address - Fax:702-442-0755
Practice Address - Street 1:6090 S FORT APACHE RD
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5658
Practice Address - Country:US
Practice Address - Phone:702-834-5777
Practice Address - Fax:702-442-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1508092958OtherTYPE 1 NPI