Provider Demographics
NPI:1053863571
Name:SCHRODER, HAGEN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:HAGEN
Middle Name:PATRICK
Last Name:SCHRODER
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 1:1221 W BEN WHITE BLVD STE 110A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:737-222-6014
Mailing Address - Fax:737-222-5986
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 110A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:737-222-6014
Practice Address - Fax:737-222-5986
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX552311ZX6WMedicare PIN