Provider Demographics
NPI:1982614756
Name:MONTGOMERY, ROTHWELL CARROLL II (DC)
Entity Type:Individual
Prefix:DR
First Name:ROTHWELL
Middle Name:CARROLL
Last Name:MONTGOMERY
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 FM 407
Mailing Address - Street 2:200
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7269
Mailing Address - Country:US
Mailing Address - Phone:940-455-2122
Mailing Address - Fax:940-455-7359
Practice Address - Street 1:4110 FM 407
Practice Address - Street 2:200
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7269
Practice Address - Country:US
Practice Address - Phone:940-455-2122
Practice Address - Fax:940-455-7359
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor