Provider Demographics
NPI:1912970070
Name:MONTELEONE, JEANETTE (DC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MONTELEONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3013
Mailing Address - Country:US
Mailing Address - Phone:719-846-2219
Mailing Address - Fax:
Practice Address - Street 1:712 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3013
Practice Address - Country:US
Practice Address - Phone:719-846-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3566111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO350031479Medicare UPIN
U37421Medicare UPIN