Montgomery Chiropractic Center Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MONTGOMERY CHIROPRACTIC CENTER INC

Practice address

684 Avon Belden Rd
Suite B
Avon Lake, OH 44012-4110

Phone

(440) 930-5537

Fax

(440) 930-5237

NPI assigned

Apr 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Andre Lamont Montgomery, DCNPI 1457315202

Title

President

Phone

(440) 930-5537

Specialties & licenses 3

Addresses

Other names 1

• Montgomery Chiropractic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Tax ID family

Montgomery Chiropractic Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Montgomery Chiropractic Center Inc

  • Durable Medical Equipment & Medical Supplies
  • Avon Lake, OH
  • NPI 1437816303
  NPD tax ID

Locations

Practitioners 2

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

• Andre Lamont Montgomery, DC

  • Chiropractor
  • Avon Lake, OH
  • NPI 1457315202
  Medicare reassignment Care Compare group NPD Authorized official
• Katherine Diane McKay, PT, DPT

  • Physical Therapist
  • North Olmsted, OH
  • NPI 1427415975
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1831155720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "684 AVON BELDEN RD",
            "address_2": "SUITE B",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440124110",
            "telephone_number": "440-930-5537",
            "fax_number": "440-930-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 AVON BELDEN RD",
            "address_2": "SUITE B",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440124110",
            "telephone_number": "440-930-5537",
            "fax_number": "440-930-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY CHIROPRACTIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-930-5537",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "3302",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montgomery Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montgomery Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joan E Mistur, LISW
• Ronald J Mistur, PHD
• Farah Mohammad
• Robert Day Monroe, DPM
• Montgomery Chiropractic Center Inc
• Andre Lamont Montgomery, DC
• Melissa Moore
• Katelyn Ann Morris, OTR/L
• John C Mullins, OD
• Kelly Mulqueen, LISW

• Chiropractor in Avon Lake, OH
• Providers in Avon Lake, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.