Derek Wade Snodgrass, D.C.
Individual provider Active NPI Chiropractor · Paducah, KY
NPI 1992971600 · NPPES record last updated Jan 9, 2017
Key facts
- NPI
- 1992971600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5190 (KY)
- Practice address
- 2725 James Sanders Blvd
Stew a
Paducah, KY 42001-8405 - Phone
- (270) 554-5114
- Fax
- (270) 554-5021
- NPI assigned
- May 2, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090707000036 | KY | Practitioner - Chiropractic | 8628141140 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benton Chiropractic, PLLC | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5190 | KY | Yes |
Addresses
Primary practice location
2725 James Sanders Blvd
Stew a
Paducah, KY 42001-8405
Mailing address
2725 James Sanders Blvd
Ste a
Paducah, KY 42001-8405
Phone (270) 554-5114
Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.