MEDICARE: SYNERGY CHIROPRACTIC, PLLC

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	133V00000X	Registered Dietitian	D-468	ID
2	111N00000X	Chiropractor	CHIA-1378	ID

General Provider Information

NPI Number	:	1912331810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	5418 N EAGLE RD
Second Line	:	STE. 120
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5418 N EAGLE RD
Second Line	:	STE. 120
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:	208-939-1500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KORY L KREUSEL
Credential	:	DC
Telephone Number	:	208-939-1500

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	03/31/2016

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