Basic Information
| Provider Information | |||||||||
| NPI: | 1396002952 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SYNERGY CHIROPRACTIC AND HEALTH CENTER PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13020 LIVINGSTON RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341055021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392633330 | ||||||||
| FaxNumber: | 2392637492 | ||||||||
| Practice Location | |||||||||
| Address1: | 13020 LIVINGSTON RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341055021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392633330 | ||||||||
| FaxNumber: | 2392637492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | AHASIC | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2392633330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH10286 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1477842821 | 01 | FL | INDIVIDUAL NPI | OTHER |