Provider Demographics
NPI:1578996294
Name:SYNERGY CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:SYNERGY CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-233-9355
Mailing Address - Street 1:6301 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5200
Mailing Address - Country:US
Mailing Address - Phone:319-233-9355
Mailing Address - Fax:
Practice Address - Street 1:6301 UNIVERSITY AVE
Practice Address - Street 2:SUITE 1250
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5200
Practice Address - Country:US
Practice Address - Phone:319-233-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06386111N00000X, 111NN1001X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty