Provider Demographics
NPI:1205188539
Name:SYNERGY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SYNERGY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COPENHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-383-9164
Mailing Address - Street 1:1509 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1731
Mailing Address - Country:US
Mailing Address - Phone:206-383-9164
Mailing Address - Fax:
Practice Address - Street 1:1509 MADISON ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1731
Practice Address - Country:US
Practice Address - Phone:206-383-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60304364261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service