Provider Demographics
NPI:1699114546
Name:SNOOK, DAVID ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:SNOOK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:ERIC
Other - Last Name:SNOOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:210 MIDDLE DAYLE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-2060
Mailing Address - Country:US
Mailing Address - Phone:217-260-7931
Mailing Address - Fax:
Practice Address - Street 1:826 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1622
Practice Address - Country:US
Practice Address - Phone:615-826-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012478111N00000X
TN3516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor