Active NPI
Ronald Dale Montgomery, DC
- Chiropractor
- Waterford, MI
National Provider Identifier
1477665115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301005148
- Practice address
- 6846 Cooley Lake Road
Waterford, MI 48327-4109 - Phone
- (248) 363-1543
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301005148 | MI | Primary |
Addresses
Primary practice location
6846 Cooley Lake Road
Waterford, MI 48327-4109
Mailing address
6846 Cooley Lake Road
Waterford, MI 48327-4109
Phone (248) 363-1543
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1754078 | Medicaid | MI | |
| 950F35099 | Other | MI | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279152000000",
"number": "1477665115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6846 COOLEY LAKE ROAD",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483274109",
"telephone_number": "248-363-1543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6846 COOLEY LAKE ROAD",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483274109",
"telephone_number": "248-363-1543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "RONALD",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2010-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301005148",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1754078",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "950F35099",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.