Provider Demographics
NPI:1679594949
Name:SYNERGY WELLNESS SOLUTIONS
Entity type:Organization
Organization Name:SYNERGY WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-737-3589
Mailing Address - Street 1:1078 BEXLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4934
Mailing Address - Country:US
Mailing Address - Phone:843-737-3589
Mailing Address - Fax:843-875-3817
Practice Address - Street 1:4491 SUMMEY ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-3214
Practice Address - Country:US
Practice Address - Phone:843-727-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2781Medicaid
SCU87793Medicare UPIN
SCCH2781Medicaid