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General NPI Number Information
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NPI Number | 1588894794
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Entity Type | Organization
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Legal Business Name | SYNERGY WELLNESS & CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 2011 W NORTHWEST HWY STE 130
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City | GRAPEVINE
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State | TX
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Zip | 76051-7853
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Country | US
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Telephone | 817-310-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 205 ISLEWORTH LN
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City | MCKINNEY
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State | TX
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Zip | 75070-2772
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Country | US
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Telephone | 817-310-0998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. R MARTIN MATISCIK
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Credential | D.C.
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Telephone | 972-302-2262
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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 | 2192
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License Number State | OH
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