Healthcare Provider Details

I. General information

NPI: 1568122216
Provider Name (Legal Business Name): MOMENTUM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 E AIRPORT AVE STE 106
BATON ROUGE LA
70806-6501
US

IV. Provider business mailing address

733 E AIRPORT AVE STE 106
BATON ROUGE LA
70806-6501
US

V. Phone/Fax

Practice location:
  • Phone: 225-218-6126
  • Fax: 225-286-7907
Mailing address:
  • Phone: 225-218-6126
  • Fax: 225-286-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CHANELL BLANCHE
Title or Position: OWNER/CHIROPRACTOR
Credential: DO
Phone: 225-218-6126