Provider Demographics
NPI:1508873621
Name:SYNERGY CHIROPRACTIC WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:SYNERGY CHIROPRACTIC WELLNESS CENTER INC.
Other - Org Name:LIFE FORCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUZANNA
Authorized Official - Last Name:LOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC NCMT
Authorized Official - Phone:815-356-9355
Mailing Address - Street 1:900 PYOTT RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8716
Mailing Address - Country:US
Mailing Address - Phone:815-356-9355
Mailing Address - Fax:815-356-9405
Practice Address - Street 1:900 PYOTT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8716
Practice Address - Country:US
Practice Address - Phone:815-356-9355
Practice Address - Fax:815-356-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208430Medicare ID - Type UnspecifiedMEDICARE