Provider Demographics
NPI:1639329006
Name:SNOW, ROBERT SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHAWN
Last Name:SNOW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:ROBERT
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:225 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5239
Mailing Address - Country:US
Mailing Address - Phone:386-424-9977
Mailing Address - Fax:386-423-3899
Practice Address - Street 1:225 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-424-9977
Practice Address - Fax:386-423-3899
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor