Provider Demographics
NPI:1043612500
Name:SCHRADER, MATTHEW CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARL
Last Name:SCHRADER
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 1:1680 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3657
Mailing Address - Country:US
Mailing Address - Phone:616-510-9128
Mailing Address - Fax:440-282-1925
Practice Address - Street 1:1680 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3657
Practice Address - Country:US
Practice Address - Phone:616-510-9128
Practice Address - Fax:440-282-1925
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor