Provider Demographics
NPI:1265634398
Name:SYFERD WELLNESS ENTITIES, P.A.
Entity Type:Organization
Organization Name:SYFERD WELLNESS ENTITIES, P.A.
Other - Org Name:LAKEWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SYFERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-463-2212
Mailing Address - Street 1:8809 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4554
Mailing Address - Country:US
Mailing Address - Phone:972-463-2212
Mailing Address - Fax:972-463-1167
Practice Address - Street 1:8809 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4554
Practice Address - Country:US
Practice Address - Phone:972-463-2212
Practice Address - Fax:972-463-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU22068Medicare UPIN