Provider Demographics
NPI:1699103416
Name:SYNERGY SOFT TISSUE
Entity type:Organization
Organization Name:SYNERGY SOFT TISSUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-245-7555
Mailing Address - Street 1:1260 N 200 E STE 16
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2382
Mailing Address - Country:US
Mailing Address - Phone:435-245-7555
Mailing Address - Fax:435-245-7607
Practice Address - Street 1:1260 N 200 E STE 16
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2382
Practice Address - Country:US
Practice Address - Phone:435-245-7555
Practice Address - Fax:435-245-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8110750-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty