Provider Demographics
NPI:1346652666
Name:TYSON SYNERGY1 SOLUTIONS, INC.
Entity Type:Organization
Organization Name:TYSON SYNERGY1 SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:TAMI
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-315-9350
Mailing Address - Street 1:161 AVENIDA BAJA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2465
Mailing Address - Country:US
Mailing Address - Phone:949-315-9350
Mailing Address - Fax:
Practice Address - Street 1:161 AVENIDA BAJA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2465
Practice Address - Country:US
Practice Address - Phone:949-315-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty