Organization Active NPI

Physical Synergy, LLC

  • Chiropractor
  • Fairfield, CT
National Provider Identifier
1497948533
Registry record updated Nov 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
001265 Issued in CT
Legal business name
PHYSICAL SYNERGY, LLC
Practice address
340 Post Rd
Fairfield, CT 06824-6220
Phone
(203) 259-3210
Fax
(203) 259-3213
NPI assigned
Aug 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Troknya, DCNPI 1669579637
Title
Owner
Phone
(203) 259-3210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 001265 CT Primary

Addresses

Primary practice location

340 Post Rd
Fairfield, CT 06824-6220

Mailing address

340 Post Rd
Fairfield, CT 06824-6220
Phone (203) 259-3210

Other identifiers 1

IdentifierTypeStateIssuer
050001265CT01OtherCTANTHEM BLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050929000847 CT Part B Supplier - Clinic/Group Practice 8527093384 Receives reassigned benefits from 4 practitioners
Practice locations: Fairfield, CT

National Provider Directory

National Provider Directory

Locations

340 Post Rd
Fairfield, CT 06824
Phone (203) 259-3210

911 Post Rd
Fairfield, CT 06824
Phone (203) 259-3210

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1497948533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246220",
            "telephone_number": "203-259-3210",
            "fax_number": "203-259-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246220",
            "telephone_number": "203-259-3210",
            "fax_number": "203-259-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL SYNERGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "TROKNYA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-259-3210",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "050001265CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.