Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0100X | Occupational Health | 21129 | CA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 21129 | CA |
NPI | 1104851229 |
---|---|
Provider Name | Dr. Mathew Alexander Snider JR. |
First Address | Sunnyvale, CA 94086-6115 |
Second Address | Sunnyvale, CA 94086-6115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 05/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0078310 | PTAN (01) | CA |
T03388 | (02) | CA |