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General NPI Number Information
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NPI Number | 1891089652
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Entity Type | Organization
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Legal Business Name | SYNERGY REHABILITAION & CHIROPRACTIC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 1048 OGDEN AVE SUITE 110
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2894
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Country | US
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Telephone | 630-322-9522
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Fax | 630-322-9515
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Provider Business Mailing Address
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Address Line | 1048 OGDEN AVE SUITE 110
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2894
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Country | US
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Telephone | 630-322-9522
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Fax | 630-322-9515
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. KURT BREWER
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Credential | D. C.
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Telephone | 630-452-8657
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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 | 038011758
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License Number State | IL
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