Organization Active NPI

Montgomery Xpress Chiropractic PLLC

  • Primary Care Clinic/Center
  • Tyler, TX
National Provider Identifier
1669719498
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
12201 Issued in TX
Legal business name
MONTGOMERY XPRESS CHIROPRACTIC PLLC
Practice address
116 E Heritage Dr.
Ste 105
Tyler, TX 75703-5159
Phone
(903) 787-7529
Fax
(903) 787-7530
NPI assigned
Jan 14, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew Montgomery, D.C.NPI 1811233703
Title
Owner, Staff Doctor
Phone
(903) 787-7529

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 12201 TX Primary

Addresses

Primary practice location

116 E Heritage Dr.
Ste 105
Tyler, TX 75703-5159

Mailing address

116 E Heritage Dr
Ste 105
Tyler, TX 75703-5150
Phone (903) 787-7529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131019000060 TX Part B Supplier - Clinic/Group Practice 5395970792 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

116 E Heritage Dr
Ste 105
Tyler, TX 75703
Phone (903) 787-7529

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1669719498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E HERITAGE DR",
            "address_2": "STE 105",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035150",
            "telephone_number": "903-787-7529",
            "fax_number": "903-787-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E HERITAGE DR.",
            "address_2": "STE 105",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035159",
            "telephone_number": "903-787-7529",
            "fax_number": "903-787-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY XPRESS CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-14",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER, STAFF DOCTOR",
        "authorized_official_telephone_number": "903-787-7529",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "12201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.