Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-007912-L | PA |
NPI | 1003828617 |
---|---|
Provider Name | Dr. Russell Thomas Montalbano |
First Address | Trooper, PA 19403-1503 |
Second Address | Norristown, PA 19401-1992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 06/05/2020 |