Healthcare Provider Details

I. General information

NPI: 1134083157
Provider Name (Legal Business Name): JACOB PAUL SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 MAIN ST
GRAMPIAN PA
16838-9337
US

IV. Provider business mailing address

258 MAIN ST
GRAMPIAN PA
16838-9337
US

V. Phone/Fax

Practice location:
  • Phone: 814-236-0700
  • Fax:
Mailing address:
  • Phone: 814-236-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC012086
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: