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Open A Healthcare Professional Account
Simply fill out the form below to open a Cyrex Laboratories healthcare professional account. Your information will be reviewed by Customer Service within 1-2 business days. If you are a healthcare professional outside of the United States, Canada, US Territories, Ireland or the United Kingdom,
Contact Us
to learn more.
*
= required field
1
Personal Information
Country:
*
Select Country
United States
American Samoa
Argentina
Australia
Belgium
Canada
Colombia
Denmark
France
Germany
Greece
Guam
Haiti
Hong Kong
India
Ireland
Japan
Malaysia
Mexico
Netherlands
New Zealand
Northern Mariana Islands
Norway
Puerto Rico
South Africa
Sweden
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
US Virgin Islands
First Name:
*
Last Name:
*
Title(s):
Phone
:
*
Fax:
Personal NPI#:
*
What's This?
Cyrex Labs requires healthcare professionals to have a personal NPI number
as these are required due to HIPAA regulations and the electronic transfer of patient information.
You can get an NPI number by calling 800-465-3203 or email
customerservice@npienumerator.com
.
Email:
*
(This will be your username)
Password:
*
(Retain for login)
Must be at least 8 characters in length and contain at least 1 numeric character, 1 uppercase and lowercase character, and 1 special character such as !@#$%^&*(){}[]
Confirm Password:
*
2
Business Information
Business Name:
*
Specialty:
*
Select Specialty
Cardiology
Chiropractic
Dermatology
Endocrinology
Neurology
Nutrition
Orthopedics
Pediatrics
Psychiatry
Rheumatology
Urology
Other
Enter your Specialty:
*
Street
:
*
Unit
:
City
:
*
State
:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York (Not available in NY)
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
*
Please help us. How did you hear about Cyrex Labs?
*
3
Licensure
License Type:
*
Select License Type
Acupuncturist (LAC)
Chiropractor (DC)
Dentist (DDS)
Doctor of Oriental Medicine (DOM)
Doctor of Osteopathic Medicine (DO)
Licensed Practical Nurse (LPN)
Medical Doctor (MD)
Naturopathic Doctor (ND)
Naturopathic Medical Doctor (NMD)
Nurse Practitioner (NP)
Nutritionist/Nutritional Therapist (NT)
Optometrist (OD)
Physician Assistant (PA)
Registered Dietician (RD)
Registered Nurse (RN)
Registered Pharmacist (RPH)
Other
Enter your license type:
*
License State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York (Not available in NY)
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
License #:
*
Issuing Board:
*
I certify that my license listed above is: a) current and active, b) free from current disciplinary action, c) granted in the State in which I practice, and d) provides authority to order testing offered by Cyrex Laboratories.
Furthermore, I certify that patients for whom I order Cyrex testing are under my direct care and supervision or that of another licensed medical professional in my practice.
Cyrex's Provider Directory
I want to be included
I DO NOT want to be included
Being listed in the Directory or information being disclosed to others does not constitute an endorsement, affiliation, sponsorship or recommendation of the provider or his/her services by Cyrex. Cyrex is under no obligation or requirement to divulge that information in part or in whole to a prospective user and any information so disclosed is at the sole discretion of Cyrex. Moreover, Cyrex will not provide the information of the prospective user to any provider listed in the directory.
I promise under penalty of perjury that the information on this form is correct to the best of my knowledge.
Enter Code:
*
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