Provider Demographics
NPI:1265564595
Name:SNYDER, ELVIRA T (DC)
Entity type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:T
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELVIRA
Other - Middle Name:BITA
Other - Last Name:HLAVATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:925 E ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2303
Mailing Address - Country:US
Mailing Address - Phone:760-728-9229
Mailing Address - Fax:
Practice Address - Street 1:925 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2303
Practice Address - Country:US
Practice Address - Phone:760-728-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17493Medicare PIN