MEDICARE: SYNERGY CHIROPRACTIC WELLNESS CENTER INC.

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		IL

General Provider Information

NPI Number	:	1508873621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY CHIROPRACTIC WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	900 PYOTT RD
Second Line	:	SUITE 108
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8716
Country	:	US
Telephone Number	:	815-356-9355
Fax Number	:	815-356-9405

Provider Business Practice Location Address
First Line	:	900 PYOTT RD
Second Line	:	SUITE 108
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8716
Country	:	US
Telephone Number	:	815-356-9355
Fax Number	:	815-356-9405

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. JENNIFER SUZANNA LOOSE
Credential	:	D.C. N.C.M.T.
Telephone Number	:	815-356-9355

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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