Provider Demographics
NPI:1558180547
Name:MONTELEONE, LOGAN J (DC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:J
Last Name:MONTELEONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BERGLUND LN STE 104
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6477
Mailing Address - Country:US
Mailing Address - Phone:321-751-5351
Mailing Address - Fax:
Practice Address - Street 1:1715 BERGLUND LN STE 104
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6477
Practice Address - Country:US
Practice Address - Phone:321-751-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor