Provider Demographics
NPI:1164744850
Name:SNIDER, JESSE RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:RYAN
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 1:43740 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1122
Mailing Address - Country:US
Mailing Address - Phone:586-228-0270
Mailing Address - Fax:586-228-9019
Practice Address - Street 1:43740 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1122
Practice Address - Country:US
Practice Address - Phone:586-228-0270
Practice Address - Fax:586-228-9019
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor