MEDICARE: MONTOYA,PC

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	7479	AZ

General Provider Information

NPI Number	:	1629419924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTOYA,PC

Provider Business Mailing Address
First Line	:	3510 N 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6608
Country	:	US
Telephone Number	:	602-954-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 N 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6608
Country	:	US
Telephone Number	:	602-954-2447
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY MONTOYA
Credential	:
Telephone Number	:	602-954-2447

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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Directions to “MONTOYA,PC ” Practice Location

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