Provider Demographics
NPI:1376850206
Name:SYNERGY, PLLC
Entity Type:Organization
Organization Name:SYNERGY, PLLC
Other - Org Name:SYNERGY CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARCELLE
Authorized Official - Last Name:FODEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-641-2367
Mailing Address - Street 1:309 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:704-326-1088
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-326-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4119261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center