Provider Demographics
NPI:1558790394
Name:SYNERGY ELITE SPORTS CLINIC
Entity type:Organization
Organization Name:SYNERGY ELITE SPORTS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HATRAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-333-2623
Mailing Address - Street 1:5850 W CYPRESS ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1738
Mailing Address - Country:US
Mailing Address - Phone:813-333-2623
Mailing Address - Fax:
Practice Address - Street 1:5850 W CYPRESS ST
Practice Address - Street 2:SUITE B1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1738
Practice Address - Country:US
Practice Address - Phone:813-333-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty