MEDICARE: SYNERGY SOFT TISSUE

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	8110750-1202	UT

General Provider Information

NPI Number	:	1699103416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY SOFT TISSUE

Provider Business Mailing Address
First Line	:	1260 N 200 E STE 16
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2382
Country	:	US
Telephone Number	:	435-245-7555
Fax Number	:	435-245-7607

Provider Business Practice Location Address
First Line	:	1260 N 200 E STE 16
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2382
Country	:	US
Telephone Number	:	435-245-7555
Fax Number	:	435-245-7607

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. TIMOTHY BAILEY
Credential	:	DC
Telephone Number	:	435-245-7555

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	12/07/2018

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Directions to “SYNERGY SOFT TISSUE ” Practice Location

Language	Start Address	Practice Location

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