Provider Demographics
NPI:1558469726
Name:SNODGRASS, JEFF SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:SCOTT
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 1:702 N MORLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2618
Mailing Address - Country:US
Mailing Address - Phone:660-263-2345
Mailing Address - Fax:660-263-2345
Practice Address - Street 1:702 N MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2618
Practice Address - Country:US
Practice Address - Phone:660-263-2345
Practice Address - Fax:660-263-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000032074Medicare ID - Type Unspecified