Provider Demographics
NPI:1083723019
Name:SCHREDER, GREGORY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:SCHREDER
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 1:2938 COLUMBIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7000
Mailing Address - Country:US
Mailing Address - Phone:717-293-1776
Mailing Address - Fax:
Practice Address - Street 1:2938 COLUMBIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7000
Practice Address - Country:US
Practice Address - Phone:717-293-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002861L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72944Medicare UPIN
PA454304Medicare PIN