Provider Demographics
NPI:1548353659
Name:MONTGOMERY, RICK (DC)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:MONTGOMERY
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 1:3818 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3326
Mailing Address - Country:US
Mailing Address - Phone:812-424-7823
Mailing Address - Fax:812-424-7824
Practice Address - Street 1:3818 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3326
Practice Address - Country:US
Practice Address - Phone:812-424-7823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002119A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200488140Medicaid
IN000000340468OtherBLUE SHIELD
IN234880AMedicare PIN