1831155720 NPI number — MONTGOMERY CHIROPRACTIC CENTER INC

Table of content: (NPI 1831155720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831155720 NPI number — MONTGOMERY CHIROPRACTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY CHIROPRACTIC CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTGOMERY CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831155720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
684 AVON BELDEN RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
AVON LAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44012-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-930-5537
Provider Business Mailing Address Fax Number:
440-930-5237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
684 AVON BELDEN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AVON LAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44012-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-930-5537
Provider Business Practice Location Address Fax Number:
440-930-5237
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
ANDRE
Authorized Official Middle Name:
LAMONT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-930-5537

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3302 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com