Provider Demographics
NPI:1316031156
Name:SNELLGROVE, DAVID L (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SNELLGROVE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2006
Mailing Address - Country:US
Mailing Address - Phone:850-477-8874
Mailing Address - Fax:850-477-8865
Practice Address - Street 1:4891 GLOVER LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4556
Practice Address - Country:US
Practice Address - Phone:850-623-2111
Practice Address - Fax:850-626-6812
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3810216-00Medicaid
FL55399YMedicare PIN
FL3810216-00Medicaid