Provider Demographics
NPI:1134290653
Name:SNYDER, NICHOLE J (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TRAVERSE TRL
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2017
Mailing Address - Country:US
Mailing Address - Phone:352-430-3399
Mailing Address - Fax:407-982-3390
Practice Address - Street 1:12517 N SAGINAW BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179
Practice Address - Country:US
Practice Address - Phone:817-422-4246
Practice Address - Fax:817-288-0775
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11635111N00000X
TX9210111N00000X
IA007687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W2410OtherBCBS PROVIDER PIN
FL1134290653OtherNPPES
7842436OtherAETNA