=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134190812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICKEY LEE SNOOK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 LANCASTER AVE
-----------------------------------------------------
City | CHRISTIANA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17509-9504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-786-1777
-----------------------------------------------------
Fax | 717-786-5193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1796 WHITE OAK RD
-----------------------------------------------------
City | STRASBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17579-9406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-786-9094
-----------------------------------------------------
Fax | 717-786-5193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC002334L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------