Provider Demographics
NPI:1811216823
Name:SYNERGY CHIROPRACTIC OF RICHLAND PC
Entity Type:Organization
Organization Name:SYNERGY CHIROPRACTIC OF RICHLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-262-0400
Mailing Address - Street 1:3209 ELTON RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2807
Mailing Address - Country:US
Mailing Address - Phone:814-262-0400
Mailing Address - Fax:814-262-0200
Practice Address - Street 1:3209 ELTON RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2807
Practice Address - Country:US
Practice Address - Phone:814-262-0400
Practice Address - Fax:814-262-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021392450001Medicaid
PA123367Medicare UPIN