Healthcare Provider Details

I. General information

NPI: 1730398785
Provider Name (Legal Business Name): JUSTIN GREGG SNYDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/18/2009
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

2418 S LOUISVILLE AVE
TULSA OK
74114-3424
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: