Provider Demographics
NPI:1831612209
Name:MONTGOMERY-NIBBE, MEGAN LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEIGH
Last Name:MONTGOMERY-NIBBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:LEIGH
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1907 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2807
Mailing Address - Country:US
Mailing Address - Phone:573-772-5451
Mailing Address - Fax:
Practice Address - Street 1:1907 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2807
Practice Address - Country:US
Practice Address - Phone:573-772-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor