Provider Demographics
NPI:1427040484
Name:SNODGRASS, DARREN L (DC)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:L
Last Name:SNODGRASS
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 1:1320 E STATE ST
Mailing Address - Street 2:STE B
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4365
Mailing Address - Country:US
Mailing Address - Phone:419-332-6840
Mailing Address - Fax:419-332-6929
Practice Address - Street 1:1320 E STATE ST
Practice Address - Street 2:STE B
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4365
Practice Address - Country:US
Practice Address - Phone:419-332-6840
Practice Address - Fax:419-332-6929
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207632Medicaid
OH2207632Medicaid