Healthcare Provider Details

I. General information

NPI: 1508957424
Provider Name (Legal Business Name): KEVIN JAMES SNYDER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 E CENTER ST
MARION OH
43302-4450
US

IV. Provider business mailing address

PO BOX 1833
MARION OH
43301-1833
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-1509
  • Fax: 740-387-4823
Mailing address:
  • Phone: 740-387-1509
  • Fax: 740-387-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: