Provider Demographics
NPI:1346270550
Name:SNELL, PHILLIP WARREN (D C)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:WARREN
Last Name:SNELL
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NE MULTNOMAH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2130
Mailing Address - Country:US
Mailing Address - Phone:971-266-0957
Mailing Address - Fax:503-994-1917
Practice Address - Street 1:9570 SE LAWNFIELD RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6676
Practice Address - Country:US
Practice Address - Phone:971-266-0957
Practice Address - Fax:503-994-1917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500623870Medicaid