Provider Demographics
NPI:1083706683
Name:SYNERGY MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SYNERGY MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-576-7000
Mailing Address - Street 1:4655 HOEN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7830
Mailing Address - Country:US
Mailing Address - Phone:707-576-7000
Mailing Address - Fax:
Practice Address - Street 1:4655 HOEN AVE STE 4
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7830
Practice Address - Country:US
Practice Address - Phone:707-576-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20427ZOtherMEDICARE PTAN