=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497291272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY ACUPUNCTURE & CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2017
-----------------------------------------------------
Last Update Date | 01/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4931 S ROUTE 59 STE 119
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-983-9608
-----------------------------------------------------
Fax | 630-355-8032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4931 S ROUTE 59 STE 119
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-983-9608
-----------------------------------------------------
Fax | 630-355-8032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JENNIFER L WISE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-983-9608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------