Provider Demographics
NPI:1043410137
Name:SYNOVIUM ENTERPRISE, INC
Entity Type:Organization
Organization Name:SYNOVIUM ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TROSCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-425-4444
Mailing Address - Street 1:9140 W 100TH AVE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6810
Mailing Address - Country:US
Mailing Address - Phone:303-425-4444
Mailing Address - Fax:303-425-4408
Practice Address - Street 1:9140 W 100TH AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6810
Practice Address - Country:US
Practice Address - Phone:303-425-4444
Practice Address - Fax:303-425-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809911Medicare PIN