Provider Demographics
NPI:1861501686
Name:SNIDER, ERIC BROCK (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BROCK
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 1:115 HARBORS WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2400
Mailing Address - Country:US
Mailing Address - Phone:305-979-4240
Mailing Address - Fax:561-731-3374
Practice Address - Street 1:1899 N CONGRESS AVE STE 9
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8215
Practice Address - Country:US
Practice Address - Phone:561-731-3361
Practice Address - Fax:561-731-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89481ZMedicare ID - Type Unspecified