Provider Demographics
NPI:1215165824
Name:MOMYER CHIROPRACTIC AND MASSAGE, P.S.
Entity type:Organization
Organization Name:MOMYER CHIROPRACTIC AND MASSAGE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MOMYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-859-2373
Mailing Address - Street 1:24604 104TH AVE. S.E.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030
Mailing Address - Country:US
Mailing Address - Phone:253-859-2373
Mailing Address - Fax:
Practice Address - Street 1:24604 104TH AVE. S.E.
Practice Address - Street 2:SUITE 203
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5385
Practice Address - Country:US
Practice Address - Phone:253-859-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty