Healthcare Provider Details

I. General information

NPI: 1093737348
Provider Name (Legal Business Name): STEPHANIE MONTEAGUDO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FINNELL DR
WEYMOUTH MA
02188-1110
US

IV. Provider business mailing address

6 NELSON ST
PLYMOUTH MA
02360-4045
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-9755
  • Fax: 781-335-7851
Mailing address:
  • Phone: 617-750-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3021
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: