Provider Demographics
NPI:1053361428
Name:SNYDER, JAYSON DALE (DC)
Entity type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:DALE
Last Name:SNYDER
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:PO BOX 446
Mailing Address - Street 2:304 W HWY 38 SUITE 122
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033
Mailing Address - Country:US
Mailing Address - Phone:605-528-6240
Mailing Address - Fax:605-528-6246
Practice Address - Street 1:304 W HWY 38
Practice Address - Street 2:SUITE 122
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033
Practice Address - Country:US
Practice Address - Phone:605-528-6240
Practice Address - Fax:605-528-6246
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7604350Medicaid
SD7604350Medicaid