Provider Demographics
NPI:1235443367
Name:SNOWDER CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:SNOWDER CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURE
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON-SNOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-283-3752
Mailing Address - Street 1:130 S WILLOW ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7744
Mailing Address - Country:US
Mailing Address - Phone:907-283-3752
Mailing Address - Fax:907-283-3792
Practice Address - Street 1:130 S WILLOW ST
Practice Address - Street 2:SUITE 7
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7744
Practice Address - Country:US
Practice Address - Phone:907-283-3752
Practice Address - Fax:907-283-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152737Medicare PIN