Provider Demographics
NPI:1952770851
Name:SYNERGY SPORTS WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:SYNERGY SPORTS WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HATRAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-352-8900
Mailing Address - Street 1:3565 PIEDMONT RD NE
Mailing Address - Street 2:BLDG 2 SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-8202
Mailing Address - Country:US
Mailing Address - Phone:404-352-8900
Mailing Address - Fax:
Practice Address - Street 1:3565 PIEDMONT RD NE
Practice Address - Street 2:BLDG 2 SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-8202
Practice Address - Country:US
Practice Address - Phone:404-352-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty