Healthcare Provider Details

I. General information

NPI: 1639336415
Provider Name (Legal Business Name): SNYDER CHIROPRACTIC P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4146 S HARVARD AVE STE F-5
TULSA OK
74135-2610
US

IV. Provider business mailing address

4146 S HARVARD AVE STE F-5
TULSA OK
74135-2610
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-7772
  • Fax: 918-749-9772
Mailing address:
  • Phone: 918-749-7772
  • Fax: 918-749-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3838
License Number StateOK

VIII. Authorized Official

Name: DR. JUSTIN G SNYDER
Title or Position: OWNER
Credential: D.C.
Phone: 918-749-7772