Provider Demographics
NPI:1174615207
Name:SNYDER, MICHAEL JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1601 DOVE ST
Mailing Address - Street 2:STE 170
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1421
Mailing Address - Country:US
Mailing Address - Phone:949-229-5297
Mailing Address - Fax:815-425-4215
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:STE 170
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1421
Practice Address - Country:US
Practice Address - Phone:949-229-5297
Practice Address - Fax:815-425-4215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC22930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor