MEDICARE: SYNERGY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2007017726	MO

General Provider Information

NPI Number	:	1164896536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	603A NE WOODS CHAPEL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1900
Country	:	US
Telephone Number	:	816-886-2035
Fax Number	:	816-503-8941

Provider Business Practice Location Address
First Line	:	603A NE WOODS CHAPEL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1900
Country	:	US
Telephone Number	:	816-886-2035
Fax Number	:	816-503-8941

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DRAKE RUSTICI
Credential	:	DC
Telephone Number	:	816-886-2035

Provider Enumeration Date	:	11/22/2015
Last Update Date	:	11/22/2015

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