Provider Demographics
NPI:1104990647
Name:SNYDER, STEPHEN (LAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1704
Mailing Address - Country:US
Mailing Address - Phone:503-231-4101
Mailing Address - Fax:
Practice Address - Street 1:3703 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1704
Practice Address - Country:US
Practice Address - Phone:503-231-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist