Provider Demographics
NPI:1750992863
Name:SEDGHI MOMENTUM HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:SEDGHI MOMENTUM HEALTH CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SEDGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-391-7221
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-0722
Mailing Address - Country:US
Mailing Address - Phone:805-541-6966
Mailing Address - Fax:
Practice Address - Street 1:6680 BAY LAUREL PL STE G
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3504
Practice Address - Country:US
Practice Address - Phone:805-541-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty