1356320113 NPI number — DR. DUANE SNIDER D.C. MSN FNP-C

Table of content: DR. DUANE SNIDER D.C. MSN FNP-C (NPI 1356320113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356320113 NPI number — DR. DUANE SNIDER D.C. MSN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNIDER
Provider First Name:
DUANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C. MSN FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356320113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 E WABASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46041-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-659-1881
Provider Business Mailing Address Fax Number:
888-846-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 E WABASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46041-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-659-1881
Provider Business Practice Location Address Fax Number:
765-659-2716
Provider Enumeration Date:
01/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001674A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 28270166C , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 71015126A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200122790A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000174402 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".