Provider Demographics
NPI:1396002952
Name:SYNERGY CHIROPRACTIC AND HEALTH CENTER PA
Entity type:Organization
Organization Name:SYNERGY CHIROPRACTIC AND HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AHASIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-263-3330
Mailing Address - Street 1:13020 LIVINGSTON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5021
Mailing Address - Country:US
Mailing Address - Phone:239-263-3330
Mailing Address - Fax:239-263-7492
Practice Address - Street 1:13020 LIVINGSTON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5021
Practice Address - Country:US
Practice Address - Phone:239-263-3330
Practice Address - Fax:239-263-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1477842821OtherINDIVIDUAL NPI
FL=========OtherTAX ID