Provider Demographics
NPI:1629159330
Name:SNAVELY, CHRIS B (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:B
Last Name:SNAVELY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2688
Mailing Address - Country:US
Mailing Address - Phone:605-842-2626
Mailing Address - Fax:605-842-3557
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2688
Practice Address - Country:US
Practice Address - Phone:605-842-2626
Practice Address - Fax:605-842-3557
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0851370001OtherDME
SD6826020Medicaid
0851370001OtherDME
SDS06828Medicare UPIN