Provider Demographics
NPI:1588894794
Name:SYNERGY WELLNESS & CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:SYNERGY WELLNESS & CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MATISCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-302-2262
Mailing Address - Street 1:205 ISLEWORTH LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2772
Mailing Address - Country:US
Mailing Address - Phone:817-310-0998
Mailing Address - Fax:
Practice Address - Street 1:2011 W NORTHWEST HWY STE 130
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7853
Practice Address - Country:US
Practice Address - Phone:817-310-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty