Provider Demographics
NPI:1952995748
Name:MOMENTUM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOMENTUM CHIROPRACTIC LLC
Other - Org Name:MOMENTUM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERAS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-510-3810
Mailing Address - Street 1:224 E BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1625
Mailing Address - Country:US
Mailing Address - Phone:813-308-3050
Mailing Address - Fax:
Practice Address - Street 1:224 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1625
Practice Address - Country:US
Practice Address - Phone:864-510-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH13445OtherFLORIDA LICENSE
FL1912565755OtherNPI