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General NPI Number Information
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NPI Number | 1548441595
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Entity Type | Organization
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Legal Business Name | SYNERGY CHIROPRACTIC AND WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 130 WALLACE RD
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8069
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Country | US
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Telephone | 386-423-2415
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Fax | 386-423-2417
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Provider Business Mailing Address
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Address Line | 130 WALLACE RD
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8069
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Country | US
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Telephone | 386-423-2415
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Fax | 386-423-2417
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD B WALSH III
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Credential | DC
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Telephone | 386-423-2415
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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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