Provider Demographics
NPI:1083153373
Name:SNYDER, NIMARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:NIMARA
Middle Name:LYNN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NIMARA
Other - Middle Name:LYNN SNYDER
Other - Last Name:GILLCRIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:29 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6725
Mailing Address - Country:US
Mailing Address - Phone:404-822-1955
Mailing Address - Fax:
Practice Address - Street 1:609 SHIPYARD BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6562
Practice Address - Country:US
Practice Address - Phone:404-822-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4674111N00000X
GA008259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor