Healthcare Provider Details

I. General information

NPI: 1194213116
Provider Name (Legal Business Name): SNYDER FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14425 LEO RD
LEO IN
46765
US

IV. Provider business mailing address

P.O. BOX 410
LEO IN
46765
US

V. Phone/Fax

Practice location:
  • Phone: 260-627-2276
  • Fax:
Mailing address:
  • Phone: 260-627-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002843A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81000150A
License Number StateIN

VIII. Authorized Official

Name: JENA LYNN SNYDER
Title or Position: CHIROPRACTOR/ACUPUNCTURIST
Credential: DC, LAC
Phone: 260-627-2276