Basic Information
| Provider Information | |||||||||
| NPI: | 1407080617 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTELLESE FAMILY CHIROPRACTIC, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MONTEREY BAY WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2695 | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939422695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313755151 | ||||||||
| FaxNumber: | 8313756682 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 CAMINO EL ESTERO | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313755151 | ||||||||
| FaxNumber: | 8313756682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2009 | ||||||||
| LastUpdateDate: | 05/04/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MONTELLESE | ||||||||
| AuthorizedOfficialFirstName: | KRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR OF CHIROPRACTIC | ||||||||
| AuthorizedOfficialTelephone: | 8313755151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC30041 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.