Provider Demographics
NPI:1407132780
Name:SYNERGY HOLISTIC HEALTH, LLC
Entity Type:Organization
Organization Name:SYNERGY HOLISTIC HEALTH, LLC
Other - Org Name:SYNERGY HOLISTIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-392-1913
Mailing Address - Street 1:25 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1109
Mailing Address - Country:US
Mailing Address - Phone:913-392-1913
Mailing Address - Fax:
Practice Address - Street 1:25 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1109
Practice Address - Country:US
Practice Address - Phone:918-392-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4022261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care