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General NPI Number Information
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NPI Number | 1730432675
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Entity Type | Organization
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Legal Business Name | SYNERGY HEALTHCARE PHYSICAL MEDICINE SC
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 350 CIMMERON DRIVE
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City | EAST PEORIA
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State | IL
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Zip | 61611
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Country | US
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Telephone | 309-688-4484
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Fax | 309-688-4485
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Provider Business Mailing Address
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Address Line | 350 CIMMERON DRIVE
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City | EAST PEORIA
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State | IL
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Zip | 61611
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Country | US
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Telephone | 309-688-4484
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Fax | 309-688-4485
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTINA D DURBIN
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Credential | DC
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Telephone | 309-688-4484
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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 | 038-008925
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-074050
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License Number State | IL
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