Provider Demographics
NPI:1811160153
Name:JOHNSON-SNOWDER, CAROLYN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
Last Name:JOHNSON-SNOWDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:SNOWDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:130 S WILLOW ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7744
Mailing Address - Country:US
Mailing Address - Phone:907-283-3752
Mailing Address - Fax:907-283-3792
Practice Address - Street 1:130 S WILLOW ST
Practice Address - Street 2:SUITE 7
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7744
Practice Address - Country:US
Practice Address - Phone:907-283-3752
Practice Address - Fax:907-283-3792
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152737Medicare PIN