Provider Demographics
NPI:1184945412
Name:SYNERGY CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:SYNERGY CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-662-4000
Mailing Address - Street 1:4347 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1831
Mailing Address - Country:US
Mailing Address - Phone:734-662-4000
Mailing Address - Fax:734-662-2182
Practice Address - Street 1:4347 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1831
Practice Address - Country:US
Practice Address - Phone:734-662-4000
Practice Address - Fax:734-662-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP8365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89664Medicare UPIN
0N74190Medicare PIN