Provider Demographics
NPI:1457419780
Name:SNYDER, MATT (DC)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:SNYDER
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 1:18008 BOTH-EV HWY SE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-485-6059
Mailing Address - Fax:425-485-6059
Practice Address - Street 1:18008 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE F
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6842
Practice Address - Country:US
Practice Address - Phone:425-485-6059
Practice Address - Fax:425-485-6059
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003044Medicaid