Provider Demographics
NPI:1003890922
Name:SCHROEDER, JEFFREY KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:SCHROEDER
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 1:1820 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1709
Mailing Address - Country:US
Mailing Address - Phone:785-856-7600
Mailing Address - Fax:785-856-7511
Practice Address - Street 1:1820 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1709
Practice Address - Country:US
Practice Address - Phone:785-856-7600
Practice Address - Fax:785-856-7511
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK01-69-1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU29013Medicare UPIN
KS062011Medicare PIN