Provider Demographics
NPI:1851541700
Name:CYNERGY CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:CYNERGY CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-542-1148
Mailing Address - Street 1:1717 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3218
Mailing Address - Country:US
Mailing Address - Phone:972-542-1148
Mailing Address - Fax:972-542-1298
Practice Address - Street 1:1717 W UNIVERSITY DR
Practice Address - Street 2:SUITE 408
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3218
Practice Address - Country:US
Practice Address - Phone:972-542-1148
Practice Address - Fax:972-542-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty