Healthcare Provider Details

I. General information

NPI: 1578996294
Provider Name (Legal Business Name): SYNERGY CHIROPRACTIC & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 UNIVERSITY AVE SUITE 1250
CEDAR FALLS IA
50613-5200
US

IV. Provider business mailing address

6301 UNIVERSITY AVE SUITE 1250
CEDAR FALLS IA
50613-5200
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-9355
  • Fax:
Mailing address:
  • Phone: 319-233-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06386
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number06386
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number06386
License Number StateIA

VIII. Authorized Official

Name: DR. MARY PAULETTE KELLY
Title or Position: OWNER
Credential: D.C.
Phone: 319-233-9355