Provider Demographics
NPI:1104806645
Name:SYNOWIEC, ROBERTA R (DC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:R
Last Name:SYNOWIEC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BERTIE
Other - Middle Name:R
Other - Last Name:SYNOWIEC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:28641 ELBAMAR DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2013
Mailing Address - Country:US
Mailing Address - Phone:734-752-9744
Mailing Address - Fax:734-675-6247
Practice Address - Street 1:28641 ELBAMAR DR
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2013
Practice Address - Country:US
Practice Address - Phone:734-752-9744
Practice Address - Fax:734-675-6247
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor