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General NPI Number Information
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NPI Number | 1447112271
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Entity Type | Organization
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Legal Business Name | SYNERGISTIC WELLNESS, LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 677 WOODLAND SQUARE LOOP SE STE C6
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City | LACEY
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State | WA
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Zip | 98503-1000
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Country | US
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Telephone | 360-349-8815
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Fax | 360-352-8868
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Provider Business Mailing Address
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Address Line | PO BOX 3773
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City | LACEY
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State | WA
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Zip | 98509-3773
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Country | US
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Telephone | 360-349-8815
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Fax | 360-352-8868
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELSEY R CLEVENGER
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Credential | DC
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Telephone | 360-764-3327
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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 |
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License Number State |
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