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General NPI Number Information
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NPI Number | 1962134239
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Entity Type | Organization
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Legal Business Name | SYNERGISTIC LABS LLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 1980 E 116TH ST
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 317-750-9364
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Fax |
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Provider Business Mailing Address
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Address Line | 380 PATRICIA CT
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City | CARMEL
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State | IN
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Zip | 46033-3277
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Country | US
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Telephone | 317-750-9364
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARIN DAVID FOX
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Credential |
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Telephone | 317-750-9364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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