Provider Demographics
NPI:1063009801
Name:SNIDER, CHARLIE LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:LAWRENCE
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 INDIANA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2835
Mailing Address - Country:US
Mailing Address - Phone:806-368-6037
Mailing Address - Fax:806-553-7283
Practice Address - Street 1:8302 INDIANA AVE STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2835
Practice Address - Country:US
Practice Address - Phone:806-368-6037
Practice Address - Fax:806-553-7283
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor