Provider Demographics
NPI:1427495464
Name:HEALTHSOURCE OF MONTGOMERY
Entity type:Organization
Organization Name:HEALTHSOURCE OF MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUERMIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-791-1888
Mailing Address - Street 1:9200 MONTGOMERY RD STE 10B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7730
Mailing Address - Country:US
Mailing Address - Phone:513-791-1888
Mailing Address - Fax:513-984-4521
Practice Address - Street 1:9200 MONTGOMERY RD STE 10B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7730
Practice Address - Country:US
Practice Address - Phone:513-791-1888
Practice Address - Fax:513-984-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty