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General NPI Number Information
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NPI Number | 1407132780
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Entity Type | Organization
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Legal Business Name | SYNERGY HOLISTIC HEALTH, LLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 25 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1109
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Country | US
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Telephone | 918-392-1913
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1109
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Country | US
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Telephone | 913-392-1913
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. DIANA DOTY
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Credential | D.C.
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Telephone | 918-392-1913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4022
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License Number State | OK
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