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		PA

General Provider Information

NPI Number	:	1720318207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	220 N BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1638
Country	:	US
Telephone Number	:	724-264-4667
Fax Number	:	724-264-4668

Provider Business Practice Location Address
First Line	:	220 N BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1638
Country	:	US
Telephone Number	:	724-264-4667
Fax Number	:	724-264-4668

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENNA MARGUARITA CLICK
Credential	:	D.C.
Telephone Number	:	724-264-4667

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	05/09/2018

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