Provider Demographics
NPI:1962593558
Name:SNODGRASS, R. B. KELLEY (DC)
Entity type:Individual
Prefix:DR
First Name:R. B. KELLEY
Middle Name:
Last Name:SNODGRASS
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 1:55 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-1208
Mailing Address - Country:US
Mailing Address - Phone:607-746-2201
Mailing Address - Fax:
Practice Address - Street 1:55 ELM ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1208
Practice Address - Country:US
Practice Address - Phone:607-746-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1962593558Medicare UPIN