Healthcare Provider Details

I. General information

NPI: 1124944285
Provider Name (Legal Business Name): RYAN DOUGLAS MONTELEONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 YOUNG ST
WILSON NY
14172-9500
US

IV. Provider business mailing address

286 YOUNG ST
WILSON NY
14172-9500
US

V. Phone/Fax

Practice location:
  • Phone: 716-751-3939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX014055-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: