Healthcare Provider Details

I. General information

NPI: 1457955197
Provider Name (Legal Business Name): SYNERGY CHIROPRACTIC CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 RICHMOND RD
STATEN ISLAND NY
10306-2560
US

IV. Provider business mailing address

PO BOX 265
MILTON NY
12547-0265
US

V. Phone/Fax

Practice location:
  • Phone: 718-502-5271
  • Fax:
Mailing address:
  • Phone: 845-616-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGI JANA ENDELADZE
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 845-616-9485