MEDICARE: DR. JENNA FLORENCE MONTANA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104-557511	VA

General Provider Information

NPI Number	:	1558846022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA FLORENCE MONTANA DC

Provider Business Mailing Address
First Line	:	1917 BURMA RD
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-2329
Country	:	US
Telephone Number	:	727-207-1536
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 BRAMBLETON AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-4308
Country	:	US
Telephone Number	:	540-755-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	06/11/2019

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