Healthcare Provider Details

I. General information

NPI: 1376672675
Provider Name (Legal Business Name): WILLIAM RANDY SNYDER D.C., L.M.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1596 LAUREL CIR
VISTA CA
92081-4548
US

IV. Provider business mailing address

1596 LAUREL CIR
VISTA CA
92081-4548
US

V. Phone/Fax

Practice location:
  • Phone: 760-650-5288
  • Fax:
Mailing address:
  • Phone: 760-650-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15395
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5313705-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: