Healthcare Provider Details

I. General information

NPI: 1124142286
Provider Name (Legal Business Name): MARK SNYDER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5942 ROSWELL RD NE
ATLANTA GA
30328-4908
US

IV. Provider business mailing address

208 WOODCLIFF DR
ATLANTA GA
30350-3158
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-2520
  • Fax: 404-255-6703
Mailing address:
  • Phone: 678-428-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007887
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: