Healthcare Provider Details

I. General information

NPI: 1962593558
Provider Name (Legal Business Name): R. B. KELLEY SNODGRASS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ELM ST
DELHI NY
13753-1208
US

IV. Provider business mailing address

55 ELM ST
DELHI NY
13753-1208
US

V. Phone/Fax

Practice location:
  • Phone: 607-746-2201
  • Fax:
Mailing address:
  • Phone: 607-746-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX3772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: