Healthcare Provider Details

I. General information

NPI: 1912331810
Provider Name (Legal Business Name): SYNERGY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 N EAGLE RD STE. 120
BOISE ID
83713-0998
US

IV. Provider business mailing address

5418 N EAGLE RD STE. 120
BOISE ID
83713-0998
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1378
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-468
License Number StateID

VIII. Authorized Official

Name: DR. KORY L KREUSEL
Title or Position: OWNER
Credential: DC
Phone: 208-939-1500