Provider Demographics
NPI:1730542416
Name:MONTIE, MALARIE J (DC)
Entity type:Individual
Prefix:
First Name:MALARIE
Middle Name:J
Last Name:MONTIE
Suffix:
Gender:F
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:E10838 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9766
Mailing Address - Country:US
Mailing Address - Phone:608-393-8169
Mailing Address - Fax:
Practice Address - Street 1:550 W MAPLE ST # 201
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1166
Practice Address - Country:US
Practice Address - Phone:608-393-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5180-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor