Provider Demographics
NPI:1952601700
Name:SNYDER PROFESSIONAL SERVICES CORP
Entity Type:Organization
Organization Name:SNYDER PROFESSIONAL SERVICES CORP
Other - Org Name:SOUTHEAST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-461-8727
Mailing Address - Street 1:71 MCADENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2434
Mailing Address - Country:US
Mailing Address - Phone:704-461-8727
Mailing Address - Fax:704-461-8729
Practice Address - Street 1:71 MCADENVILLE RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2434
Practice Address - Country:US
Practice Address - Phone:704-461-8727
Practice Address - Fax:704-461-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890824TMedicaid