Provider Demographics
NPI:1477879781
Name:SNIDER, JUSTIN LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LANE
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 1:359 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2926
Mailing Address - Country:US
Mailing Address - Phone:864-681-0555
Mailing Address - Fax:
Practice Address - Street 1:359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2926
Practice Address - Country:US
Practice Address - Phone:864-681-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor