Provider Demographics
NPI:1588817100
Name:SNOOK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SNOOK CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-384-4339
Mailing Address - Street 1:600 W REX ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1141
Mailing Address - Country:US
Mailing Address - Phone:520-384-4339
Mailing Address - Fax:
Practice Address - Street 1:600 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1141
Practice Address - Country:US
Practice Address - Phone:520-384-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164424156OtherINDIVIDUAL NPI
AZ1164424156OtherINDIVIDUAL NPI
AZU68523Medicare UPIN