Basic Information
| Provider Information | |||||||||
| NPI: | 1942354709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTZ-GOBLE | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16500 STATE HIGHWAY 76 | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656254115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178475081 | ||||||||
| FaxNumber: | 4178471911 | ||||||||
| Practice Location | |||||||||
| Address1: | 16500 STATE HIGHWAY 76 | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656254115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178475081 | ||||||||
| FaxNumber: | 4178471911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 005095 | MO | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 3086 | 01 | MO | ANTHEM BCBS | OTHER |