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General NPI Number Information
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NPI Number | 1548755234
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Entity Type | Organization
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Legal Business Name | MOMENTUM WELLNESS AND PERFORMANCE
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 2137 5TH AVE
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City | WEST LINN
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State | OR
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Zip | 97068-4603
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Country | US
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Telephone | 619-743-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 2137 5TH AVE
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City | WEST LINN
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State | OR
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Zip | 97068-4603
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Country | US
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Telephone | 619-743-5502
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. JEFFREY ALLEN ZELASKO
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Credential | D.C.
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Telephone | 619-743-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5812
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License Number State | OR
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