Provider Demographics
NPI:1720318207
Name:MOMENTUM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOMENTUM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNA
Authorized Official - Middle Name:MARGUARITA
Authorized Official - Last Name:CLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-264-4667
Mailing Address - Street 1:220 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1638
Mailing Address - Country:US
Mailing Address - Phone:724-264-4667
Mailing Address - Fax:724-264-4668
Practice Address - Street 1:220 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1638
Practice Address - Country:US
Practice Address - Phone:724-264-4667
Practice Address - Fax:724-264-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty