Provider Demographics
NPI:1053390740
Name:SNELLER, SCOTT DEAN (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DEAN
Last Name:SNELLER
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 1:3930 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-5166
Mailing Address - Country:US
Mailing Address - Phone:712-276-4325
Mailing Address - Fax:712-276-6033
Practice Address - Street 1:3930 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5166
Practice Address - Country:US
Practice Address - Phone:712-276-4325
Practice Address - Fax:712-276-6033
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025541100Medicaid
IA1152017Medicaid
IAI7761Medicare ID - Type Unspecified
NE10025541100Medicaid