Provider Demographics
NPI:1982065827
Name:MOMENTUM FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MOMENTUM FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:TIBBITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-454-5100
Mailing Address - Street 1:613 UPTOWN BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3512
Mailing Address - Country:US
Mailing Address - Phone:469-454-5100
Mailing Address - Fax:
Practice Address - Street 1:613 UPTOWN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3512
Practice Address - Country:US
Practice Address - Phone:469-454-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13046111N00000X
TX11783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty