Provider Demographics
NPI:1013950179
Name:SNYDER, AMY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S. EAST ST.
Mailing Address - Street 2:
Mailing Address - City:TOULON
Mailing Address - State:IL
Mailing Address - Zip Code:61483
Mailing Address - Country:US
Mailing Address - Phone:309-286-2400
Mailing Address - Fax:
Practice Address - Street 1:104 S. EAST ST.
Practice Address - Street 2:
Practice Address - City:TOULON
Practice Address - State:IL
Practice Address - Zip Code:61483
Practice Address - Country:US
Practice Address - Phone:309-286-2400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210615Medicare ID - Type Unspecified
ILU83865Medicare UPIN