Healthcare Provider Details

I. General information

NPI: 1316388044
Provider Name (Legal Business Name): SNYDER CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 ORANGE AVE
CORONADO CA
92118-1826
US

IV. Provider business mailing address

543 ORANGE AVE
CORONADO CA
92118-1826
US

V. Phone/Fax

Practice location:
  • Phone: 314-255-8944
  • Fax: 619-437-4909
Mailing address:
  • Phone: 314-255-8944
  • Fax: 619-437-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32166
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH NICHOLAS SNYDER
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 314-255-8944