MEDICARE: DIANA LYNN SNOOK DC

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	111NN1001X	Nutrition Chiropractor	5365	AZ

General Provider Information

NPI Number	:	1164424156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LYNN SNOOK DC

Provider Business Mailing Address
First Line	:	145 E MALEY ST
Second Line	:
City	:	WILLCOX
State	:	AZ
Zip	:	85643-2127
Country	:	US
Telephone Number	:	520-384-4339
Fax Number	:	520-384-4351

Provider Business Practice Location Address
First Line	:	145 E MALEY ST
Second Line	:
City	:	WILLCOX
State	:	AZ
Zip	:	85643-2127
Country	:	US
Telephone Number	:	520-384-4339
Fax Number	:	520-384-4351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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Directions to “ DIANA LYNN SNOOK DC” Practice Location

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