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General NPI Number Information
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NPI Number | 1124393814
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Entity Type | Organization
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Legal Business Name | SYNERGY CHIROPRACTIC SPINE & JOINT CENTER
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 1399 DUNDEE DR
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City | WATERFORD
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State | MI
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Zip | 48327-2005
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Country | US
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Telephone | 248-330-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 58 PHYSICIANS DR STE 102
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City | SUPPLY
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State | NC
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Zip | 28462-4226
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Country | US
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Telephone | 248-330-1499
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. KURT ROBERT COOPER
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Credential | D.C.
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Telephone | 248-330-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4239
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License Number State | NC
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