Active NPI
Roy Montgomery Wilburn, D.C.
- Sports Physician Chiropractor
- Fort Collins, CO
National Provider Identifier
1699885558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 3311
- Practice address
- 1035 Robertson St
Fort Collins, CO 80524-3926 - Phone
- (970) 224-2282
- Fax
- (970) 495-6955
- NPI assigned
- Aug 30, 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 |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 3311 | CO | Primary |
Addresses
Primary practice location
1035 Robertson St
Fort Collins, CO 80524-3926
Mailing address
1035 Robertson St
Fort Collins, CO 80524-3926
Phone (970) 224-2282
Other names 1
- Dr. Monty Wilburn
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120426000068 | CO | Practitioner - Chiropractic | 4880856533 | Practice locations: Fort Collins, CO |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3311 | CO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699885558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 ROBERTSON ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805243926",
"telephone_number": "970-224-2282",
"fax_number": "970-495-6955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 ROBERTSON ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805243926",
"telephone_number": "970-224-2282",
"fax_number": "970-495-6955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBURN",
"first_name": "ROY",
"middle_name": "MONTGOMERY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CO",
"license": "3311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MONTY",
"last_name": "WILBURN",
"prefix": "DR.",
"credential": "D.C.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.