MEDICARE: SYNAPSE CHIROPRACTIC CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1477018125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNAPSE CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	4711 CHARDONNAY LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-7481
Country	:	US
Telephone Number	:	386-682-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 SILVER BEACH AVE STE 101
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-7104
Country	:	US
Telephone Number	:	386-682-9350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RYAN REVELS
Credential	:	DC
Telephone Number	:	386-682-9350

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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