Provider Demographics
NPI:1003828617
Name:MONTALBANO, RUSSELL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:THOMAS
Last Name:MONTALBANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TROOPER
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1503
Mailing Address - Country:US
Mailing Address - Phone:484-256-4832
Mailing Address - Fax:
Practice Address - Street 1:122 MILL ROAD
Practice Address - Street 2:
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456
Practice Address - Country:US
Practice Address - Phone:484-256-4832
Practice Address - Fax:484-612-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007912-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor