Healthcare Provider Details

I. General information

NPI: 1528384625
Provider Name (Legal Business Name): AARON MONTGOMERY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 NW CIVIC DR
GRESHAM OR
97030-5569
US

IV. Provider business mailing address

1450 NE VILLAGE ST
FAIRVIEW OR
97024-3827
US

V. Phone/Fax

Practice location:
  • Phone: 503-512-1040
  • Fax: 503-662-7334
Mailing address:
  • Phone: 503-983-6497
  • Fax: 503-512-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4015
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: