MEDICARE: MOMENTUM CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1073376455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	7050 S HIGHLAND DR STE 240
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3761
Country	:	US
Telephone Number	:	801-874-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 S HIGHLAND DR STE 240
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3761
Country	:	US
Telephone Number	:	801-874-9620
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER KHANIN
Credential	:	DC
Telephone Number	:	801-874-9620

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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