Provider Demographics
NPI:1386978419
Name:SYNERGY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SYNERGY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-268-7352
Mailing Address - Street 1:N1739 LILY OF THE VALLEY DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9105
Mailing Address - Country:US
Mailing Address - Phone:920-268-7352
Mailing Address - Fax:920-757-6446
Practice Address - Street 1:N1739 LILY OF THE VALLEY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-9105
Practice Address - Country:US
Practice Address - Phone:920-268-7352
Practice Address - Fax:920-757-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI452612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty