Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 812 | OH |
NPI | 1275517500 |
---|---|
Provider Name | Dr. Thomas Paul Montgomery |
First Address | Cortland, OH 44410-1432 |
Second Address | Cortland, OH 44410-1432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0474768 | (05) | OH |
T47177 | (02) | OH |