Provider Demographics
NPI:1164424156
Name:SNOOK, DIANA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SNOOK
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 1:145 E MALEY ST
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-2127
Mailing Address - Country:US
Mailing Address - Phone:520-384-4339
Mailing Address - Fax:520-384-4351
Practice Address - Street 1:145 E MALEY ST
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-2127
Practice Address - Country:US
Practice Address - Phone:520-384-4339
Practice Address - Fax:520-384-4351
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5365111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102558Medicare ID - Type Unspecified
AZU68523Medicare UPIN