1639113913 NPI number — SNOOK CHIROPRACTIC AND NUTRITION CENTER, P.C.

Table of content: (NPI 1639113913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639113913 NPI number — SNOOK CHIROPRACTIC AND NUTRITION CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNOOK CHIROPRACTIC AND NUTRITION CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639113913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BART
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17503-0145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-786-1777
Provider Business Mailing Address Fax Number:
717-786-5193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17509-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-786-1777
Provider Business Practice Location Address Fax Number:
717-786-5193
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNOOK
Authorized Official First Name:
RICKEY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
717-786-1777

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  DC002334L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02638700 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1031375 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 081786 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 183544SOC . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SN1618842 . This is a "HIGHMARK BLUE SHEILD GROU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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