Provider Demographics
NPI:1336874072
Name:MOMENTUM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOMENTUM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-330-6080
Mailing Address - Street 1:PO BOX 10108
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-0108
Mailing Address - Country:US
Mailing Address - Phone:507-330-6080
Mailing Address - Fax:
Practice Address - Street 1:8 DODIER CT
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2536
Practice Address - Country:US
Practice Address - Phone:507-330-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty