Healthcare Provider Details

I. General information

NPI: 1447638242
Provider Name (Legal Business Name): MVMT SPORT & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18777 N 32ND ST STE 80
PHOENIX AZ
85050-3202
US

IV. Provider business mailing address

18777 N 32ND ST STE 80
PHOENIX AZ
85050-3202
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-3365
  • Fax:
Mailing address:
  • Phone: 480-788-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8453
License Number StateAZ

VIII. Authorized Official

Name: DR. JUSTINE N LOMBOY
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 480-788-3365