Provider Demographics
NPI:1285751750
Name:MOMENTUM CHIROPRACTIC
Entity type:Organization
Organization Name:MOMENTUM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-661-1772
Mailing Address - Street 1:1360 9TH AVE
Mailing Address - Street 2:220
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2372
Mailing Address - Country:US
Mailing Address - Phone:415-661-1772
Mailing Address - Fax:415-661-1792
Practice Address - Street 1:1360 9TH AVE
Practice Address - Street 2:220
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2372
Practice Address - Country:US
Practice Address - Phone:415-661-1772
Practice Address - Fax:415-661-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0279930Medicare PIN