Provider Demographics
NPI:1184829376
Name:MOMENTUM HEALTH CARE PC
Entity Type:Organization
Organization Name:MOMENTUM HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-544-9696
Mailing Address - Street 1:7070 N ORACLE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4337
Mailing Address - Country:US
Mailing Address - Phone:520-544-9696
Mailing Address - Fax:520-544-8197
Practice Address - Street 1:7070 N ORACLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4337
Practice Address - Country:US
Practice Address - Phone:520-544-9696
Practice Address - Fax:520-544-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72761Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID