Provider Demographics
NPI:1922378876
Name:SYNERGY WELLNESS
Entity Type:Organization
Organization Name:SYNERGY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANLOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-408-8183
Mailing Address - Street 1:1775 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7206
Mailing Address - Country:US
Mailing Address - Phone:248-408-8183
Mailing Address - Fax:
Practice Address - Street 1:1775 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7206
Practice Address - Country:US
Practice Address - Phone:248-408-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty