MEDICARE: SYNERGY REHABILITAION & CHIROPRACTIC

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	038011758	IL

General Provider Information

NPI Number	:	1891089652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY REHABILITAION & CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1048 OGDEN AVE
Second Line	:	SUITE 110
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-322-9522
Fax Number	:	630-322-9515

Provider Business Practice Location Address
First Line	:	1048 OGDEN AVE
Second Line	:	SUITE 110
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-322-9522
Fax Number	:	630-322-9515

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KURT BREWER
Credential	:	D. C.
Telephone Number	:	630-452-8657

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	01/04/2012

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