Healthcare Provider Details

I. General information

NPI: 1174737506
Provider Name (Legal Business Name): AUDUBON PARK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 W NORTHWEST BLVD
SPOKANE WA
99205-2378
US

IV. Provider business mailing address

2909 W NORTHWEST BLVD
SPOKANE WA
99205-2378
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-4049
  • Fax: 509-327-0772
Mailing address:
  • Phone: 509-327-4049
  • Fax: 509-327-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2743
License Number StateWA

VIII. Authorized Official

Name: DR. JAMES ROY SNYDER
Title or Position: OWNER
Credential: DC
Phone: 509-327-4049