Provider Demographics
NPI:1447638242
Name:MVMT SPORT & WELLNESS, PLLC
Entity type:Organization
Organization Name:MVMT SPORT & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-788-3365
Mailing Address - Street 1:18777 N 32ND ST STE 80
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3202
Mailing Address - Country:US
Mailing Address - Phone:480-788-3365
Mailing Address - Fax:
Practice Address - Street 1:18777 N 32ND ST STE 80
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3202
Practice Address - Country:US
Practice Address - Phone:480-788-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty